QAPI 97 - A Seven-year Review of Hospital-onset Clostridioides Difficile Reduction and the Case for a Multidisciplinary Taskforce Approach

Background: Hospital-onset Clostridioides difficile infection (HO-CDI) is a life-threatening disease that can prolong and complicate a patient's hospitalization. To reduce HO-CDIs and ensure positive health outcomes with reduced cost, utilization of a multi-disciplinary taskforce (MDT) is key to identify gaps, develop action plans, and implement and review interventions in the most efficient and effective manner.

Methods: Over the course of seven years, two rounds of interventions were executed consecutively across a nine-hospital healthcare system to reduce HO-CDI events. The first round (Round 1) driven solely by the Infection Prevention (IP) department spanned four years and consisted of three phases of interventions. The second round (Round 2) led by an MDT was comprised of ten disciplines and likewise had three phases of interventions. Timespan and interventions varied between all phases. Data reported to National Healthcare Safety Network (NHSN) were used for statistical analysis. Intervention effectiveness of each phase was measured using a 2x3 Chi-square test, and a 2x2 Chi-square test was used to compare the IP-only versus the MDT approach styles.

Results: Throughout the entire process improvement endeavor, the MDT approach style demonstrated by Round 2 revealed higher efficiency and effectiveness with HO-CDI reduction accounting for 38.7% (654/1,689, p= <.001) events reported to NHSN in a three-year period compared to events from Round 1. Furthermore, Phase 3 of Round 2 showed most successful, accounting for only 6.3% (11/175, p= <.02) of all interventions from both rounds.

Conclusions: From the start of the MDT to its end, the healthcare system observed an overall HO-CDI reduction of 81.6%. The review of this healthcare system's process improvement course to reduce HO-CDIs reveals utilization of a MDT approach allows for key stakeholders to participate in decision-making, consequently reinforcing ownership of interventions at each phase across the board for a more efficient and effective implementation to sustainable positive results.