Background: Clostridioides difficile (C. difficile) is a spore-forming anaerobic bacterium that causes diarrhea to life-threatening intestinal conditions. According to the study done by Centers for Disease Control in 2011, clostridioides difficile infection (CDI) can cause immense suffering and mortality for thousands of Americans. CDI is acquired from an endogenous source or from spores in the environment, most easily acquired during hospitalization. Compliance with evidence-based practices is known to reduce hospital-onset C. difficile infections and increased patient safety.
Problem: The rate of hospital-onset CDI among the adult inpatient population at Johns Hopkins Bayview increased in 2017 and through 2018.
Goals • To reduce hospital-onset C. difficile infection rate to the hospital benchmark • To implement a multidisciplinary, multi-faceted approach to reduce hospital-acquired C. difficile
Pre- and post-measures • NHSN hospital-onset C. difficile rate • Clostridiodes difficile heat map
Action steps: C. difficile heat map updated weekly and available to all staff • Daily C. difficile rounding by HEIC team • Nursing orientation revised to include pertinent C. difficile care and prevention strategies • Represented organization in the Maryland SPARC (Statewide Prevention and Reduction of C. Difficile Collaborative) • High-impact C. difficile prevention tips article developed for in-hospital publication for nursing • Feedback provided at unit-based safety rounds • Developed isolation guidelines disseminated to staff and patient care coordinators Conducted a one-year follow-up survey on earlier knowledge gaps identified • HERO events entered to provide for individual feedback to staff as needed • Developed a clostridiodes difficile provider guide and posted in work areas • Included C. difficile information in annual intern orientation • Daily calls to EVS to identify patient care rooms for UV light terminal cleaning
Conclusion: There was a 30% reduction in the hospital-onset C. difficile rate for JHBMC for calendar year 2019. These efforts saved patients’ lives and helped significantly reduce unnecessary health care-associated costs. The multidisciplinary efforts have contributed to the recent improvement in hospital-onset C. difficile cases. It is likely that this multifaceted approach will be sustained to ensure early detection, reduce risk of transmission, and increase patient safety.
MSN/Ed, RN, CMSRN, ONC, CBN, CNE,
Advanced Clinical Registered Nurse,
Johns Hopkins Bayview Medical Center
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