Clostridioides difficile Infection Reduction Collaborative
Healthcare-associated infections (HAI) are estimated to occur in 1.7 million patients in the US, leading to 99,000 deaths and resulting in additional cost of $28 to 33 billion. Clostridioides difficile infection (CDI) has become one of the most common HAIs.
In the U.S., it is estimated that CDI causes 165,000 cases annually, 1.3 billion in excess cost and 9,000 deaths. CDI are a significant burden on hospitals due to increased length of stay and cost and up to 20% of CDI cases are associated with recurrences leading to hospitalization and increased cost of outpatient treatment. Therefore, CDI represents a significant economic burden and although excess attributable cost varies, studies indicate it may add about 7 days to the length of stay and $4,000 to the cost per case. Locally hospitals report that this disease is associated with sepsis, readmission and even death. The purpose of the Collaborative is to reduce the incidence of C. difficile disease in four Rochester hospitals.
Goals and Objectives
- Reduce the burden of CDI in hospitalized patients by 30%
- Reduce the burden of CDI in key community skilled nursing facilities by 30%
- Reduce the burden of CDI in our community by 30%
The Rochester Patient Safety Collaborative (RPSC) consists of hospital epidemiologists and experienced Infection Preventionists (IPs) led by CDSP staff. The group has worked together for several years on different infectious disease projects such as the CLABSI quality improvement project.
Starting in 2011, the RPSC initiated a quality improvement project to prevent CDI in hospitalized patients at 4 hospitals in Rochester: Strong Memorial Hospital, Highland Hospital, Rochester General Hospital and Unity Hospital. Our prevention efforts focused on limiting CDI transmission by emphasizing hand hygiene and adequate cleaning of the environment through involvement of staff from multiple disciplines, education, observations, standardization of policies, behavioral change theory implementation and antibiotic stewardship. CDI is a threat across the healthcare continuum, leading to the eventual expansion of our efforts to nursing homes. Using the methods listed below, a reduction in hospital-onset CDI of over 30% was achieved.
- Establishing an NHSN communication network to gather data on the incidence of CDI at the 4 hospitals and the community and understand the scope of CDI in the Rochester community
- Assessing existing policies and practices relating to CDI prevention at different hospitals in the greater Rochester area
- Standardizing best practices for CDI prevention across greater Rochester area
- Monitoring adherence to standardized policies
- Increasing education and awareness of CDI and the best practices for CDI prevention and control
- Monitoring hospital antibiotic use and implementing education and restrictions pertaining to the use of quinolories
Several workshops and educational sessions were held throughout the project. For more information, please visit www.rochesterpatientsafety.com.
Ghinwa Dumyati, M.D., Communicable Diseases Surveillance and Prevention Program Director and Professor of Medicine in Infectious Disease at University of Rochester Medical Center, presented on the group's collaborative work as part of the Clinical & Translational Science Institute's Seminar Series.