Illinois Hospitals Collaborate to Reduce Clostridium difficile Infections

Based on CDC recommendations, IDPH and IFMC-IL chose several prevention strategies to constitute a C. difficile prevention bundle that included hand hygiene, contact precautions, environmental cleaning, lab alerts, and staff and patient education. Hospitals had the option of adding other strategies based on individual needs identified. Each team performed a gap analysis to identify specific goals and action steps. IDPH and IFMC-IL supported hospital efforts through site visits, webinars, sharing calls, and in-person meetings. Most of these learning activities were held separately for each cohort.

Hospital-onset (HO) CDI rates decreased in both cohorts. Hospitals reported C. difficile laboratory data to CDC’s National Healthcare Safety Network (NHSN). For cohort 1 (metro Chicago), the model-predicted HO CDI incidence decreased from 11.7 to 9.8 cases per 10,000 patient days during the 19-month participation period, a 15% decrease that was marginally significant. For cohort 2 (central and southern Illinois), the model-predicted HO CDI incidence decreased from 9.1 to 6.7 cases per 10,000 patient days during the 12-month participation period, a 26% decrease. Two months after the collaborative ended, data indicate the decrease in HO CDI rates has been sustained; the model-predicted decrease was 18% (p=0.02) for cohort 1 and 22% (p=0.19) for cohort 2.

Hospitals completed an adapted version of the CDC Prevention Practices Assessment Tool at the beginning and end of participation, and provided monthly hand hygiene, gown and glove, and environmental cleaning adherence rates via NHSN. Monitoring of these prevention practices was higher at the end of the participation period compared to the beginning. Adherence rates also increased by the end of the participation period in both cohorts. Adherence rates were highest for hand hygiene (93% in cohort 2) and lowest for environmental cleaning (78% in cohort 2). IDPH presented lessons learned in the Not Just a Maid Service video, which highlights the role of environmental service workers in preventing CDI (www.notjustamaidservice.com).

• Forming multidisciplinary teams was important, particularly for enhancing communication across departments and gaining better appreciation for each staff member’s role in preventing CDI.
• Education and resources for environmental cleaning was an area of high interest and need.
• It is important to consider how to sustain the successes achieved beyond the collaborative period.
• Support from hospital leadership is important for long-term success, and leadership from the state can strengthen facilities’ CDI prevention efforts.
• Hospitals have competing priorities and more needs to be done to get them to prioritize CDI prevention.