QAPI 23 - Sustained Reduction of Hospital-onset Clostridioides Difficile: A Multimodal Approach

Wednesday, June 28, 2023

3:51 PM – 4:10 PM

Location: W103 A/B; Orange County Convention Center

CE: 0.33

CNE Credits: 0.33
CME Credits: 0.33

Presenter(s)

Stephanie DiGiovanni, MA, BSN, RN, CIC

Director, Infection Prevention
NYU Langone- Long Island
Lynbrook, New York

Disclosure(s): No financial relationships to disclose

PDF

Co-Author(s)

Diane H. Johnson, MD

Chief, Division of Infectious Diseases, Hospital Epidemiologist
NYU Langone Hospital- Long Island
Mineola, New York

Co-Author(s)

Ranekka Dean, PhD RN CIC FAPIC

System Senior Director
NYU Langone Health
West Hempstead, New York
Corinne Thompson, PhD (she/her/hers)

Epidemiologist
NYU
New York, New York
KC

Karen Campos, n/a

Sr. Project Manager
NYU Langone Hospital-Long Island
Mineola, New York
PS

Patricia Saroop, MBA HCM (she/her/hers)

Project Manager
NYU Langone Health - Long Island, New York

Moderator(s)

Luz Caicedo, MPH, CPH, CIC, CRCST, VA-BC

Infection Prevention Manager
AdventHealth Celebration, Florida

Disclosure(s): No financial relationships to disclose

Co-Moderator(s)

Krista Doline, BS, MLS (ASCP), CIC, FAPIC

Infection Preventionist
Piedmont Healthcare
Fayetteville, Georgia

Disclosure(s): No financial relationships to disclose

Background: Clostridioides difficile infection (CDI) is the most common organism causing healthcare-associated infections in the United States. CDI rates were above organizational target goal due to delayed testing and variable adherence to the existing processes. There were inconsistencies in the processes that impacted our quality of care and our metrics. Through standardization of the processes there was opportunity to improve the quality of care.

Methods: Over the past two years, a multidisciplinary team worked with staff to improve early recognition of community-onset CDI and to minimize any barriers to testing within the first three days of hospitalization. An existing tip sheet was revised to ensure that specimens met testing criteria. Education was provided to front line staff on the early testing of patients presenting with loose stool in the first seventy-two hours of hospitalization. In November 2021, implementation of Medical Unit Director (MUD) approval was required for any C. difficile order placed on hospital day three or later. The ordering process required the provider to select the approver name in the electronic medical record. Apparent Cause Analyses were performed on all hospital-onset (HO) cases to identify opportunities for improvement.

Results: The median monthly rate of HO CDI from January 2021 – October 2021 was 4.29 per 10,000 patient days. Following the implementation of the MUD approval process in November 2021 through July 2022, the median monthly rate dropped to 1.68 per 10,000 patient days (p=0.006, Wilcoxon ranked sum test). This represented a 61% difference in case rate per month, and was associated with a drop in a median of 3 HO CDI per month

Conclusions: Early recognition and testing for CDI along with a standardized testing process which included formalized approval by the medical unit director resulted in significant and sustained decrease in HO CDI.

Learning Objectives:

Recognize inconsistencies in current CDI processes that impact quality of care and organizational metrics.
Describe the benefit of using a standardized testing process to reduce hospital-onset CDI.
Implement comprehensive testing stewardship to improve patient safety.