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Background: Since 2015 the rate of healthcare facility-onset Clostridium difficile infections (HO CDI) at Faxton-St Luke’s Healthcare (FSLH) has remained higher than both New York state and federal benchmarks, despite the use of traditional prevention efforts. Methods: We used the define-measure-analyze-improve-control (DMAIC) process improvement model to better understand the reasons that our rates remained high and to develop a comprehensive reduction strategy.
• Define: High HO CDI rates. NHSN SIR consistently above 1.0
• Measure
• Diagnostic stewardship. Are patients being tested appropriately?
• Antibiotic stewardship: Do prescribing practices follow best-practice recommendations?
• Environmental cleanliness: Are staff following standard and transmission based precautions? How effective are current cleaning practices? What is being done to limit contamination of the environment of care?
• Perform a gap analysis of CDI prevention strategies at FSLH vs current best practice recommendations, emerging strategies in scientific literature and successful approaches at other health-care facilities.
• Analyze
• Staff do not have a clear understanding of symptoms and risk factors of CDI and often initiate testing inappropriately.
• Overuse of broad spectrum antimicrobial agents. No antibiotic time outs. Limited Pharmacy staff available for auditing and feedback regarding prescribing practices.
• UV disinfection system under-utilized. Shared patient care equipment not cleaned between uses. Delay in implementation of contact precautions. Lack of opportunities for patient hand hygiene.
• Improve
• Algorithms for screening and testing built into Electronic Medical Record Orders for testing coupled with orders for contact precautions
• Align antimicrobial prescribing with best practice
• Audit and reward compliance with UV light utilization, environmental cleaning Reduce shared patient care equipment, replace with disposable items
• Provide products for patient hand hygiene
• Implement marketing campaign to tie elements together
• Control
• Audit compliance with testing and isolation policies
• Laboratory rejection of formed stools
• Audit cleaning processes with adenosine triphosphate (ATP) monitor
• Track ultraviolet light usage
Funding: None
Disclosures: None
