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Proposed Checklist of Hospital Interventions to Decrease the Incidence of Healthcare-Associated Clostridium difficile Infection

Published online by Cambridge University Press:  02 January 2015

Sarah K. Abbett ,
Deborah S. Yokoe ,
Stuart R. Lipsitz ,
Angela M. Bader ,
William R. Berry ,
Elise M. Tamplin  and
Atul A. Gawande
Sarah K. Abbett
Affiliation:
Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
Deborah S. Yokoe
Affiliation:
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
Stuart R. Lipsitz
Affiliation:
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
Angela M. Bader
Affiliation:
Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
William R. Berry
Affiliation:
Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
Elise M. Tamplin
Affiliation:
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
Atul A. Gawande*
Affiliation:
Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
*
Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 ([email protected])
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Abstract

Background.

The incidence and severity of Clostridium difficile infection (CDI) are increasing, and previously described interventions for controlling the spread of CDI are not easily generalized to multiple healthcare institutions.

Objective.

We tested prevention and treatment bundles to decrease the incidence of CDI and the mortality associated with CDI at our hospital.

Design.

Observational before-after study of adult patients admitted to a tertiary care, university-affiliated hospital during the period from January 2004 through December 2008.

Methods.

In January 2006, we launched an educational campaign and introduced a prevention bundle—a series of specific processes aimed at preventing the transmission of C. difficile among hospitalized patients, including enhanced isolation practices, laboratory notification procedures, and steps coordinating infection control and environmental services activities. In April 2006, we implemented a treatment bundle—a set of hospital-wide treatment practices aimed at minimizing the risk of serious CDI complications. We tracked quarterly incidence rates and case-fatality rates for healthcare-associated CDI cases at our hospital. Our main outcome was the healthcare-associated CDI incidence rate, measured as the number of healthcare-associated cases of CDI per 1,000 patient-days.

Results.

We followed patients for a total of 1,047,849 patient-days. The healthcare-associated CDI incidence rates fell from an average of 1.10 cases per 1,000 patient-days before intervention to 0.66 cases per 1,000 patient-days after intervention. This statistically significant decrease amounts to a 40% reduction in incidence after the intervention.

Conclusions.

Our intervention was successful in reducing the incidence of CDI at our hospital. On the basis of our experience, we propose the use of a checklist of hospital interventions to decrease the incidence of healthcare-associated CDI.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 11 , November 2009 , pp. 1062 - 1069
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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