Initiation of a Performance Review Committee (PRC) with Multidisciplinary Healthcare Team Members and the Impact on Hospital-Acquired Clostridium difficile Infection (CDI)

Abstract

Background. Clostridium difficile infection (CDI) is considered an urgent public health threat. A 2012 evaluation of CDI cases identified an increased length of stay of 7.19 days with an additional $12,500 in costs compared with cases without CDI. The Centers for Disease Control and Prevention provide a CDI prevention primer toolkit of best practices with approaches for hospital-acquired CDI (HA-CDI) reduction. The senior leadership at Florida Hospital Orlando recognized the importance of reduction of HA-CDI and tasked a multidisciplinary healthcare team as a PRC to implement the Centers for Disease Control and Prevention toolkit and best practices. Methods. This was a quasi-experimental study design implementing a bundle of interventions. The hypothesis was made that if the following events occurred, the incidence of HA-CDI would decrease: 1. early identification of community-onset CDI, 2. reduction or elimination of environmental reservoirs of the spore, 3. minimal skin contamination, and 4. judicious use of antimicrobial and acid suppression agents. The interventions were implemented over 1 year rather concurrently at our 1289- bed, acute care community hospital. The PRC convened weekly with recommendations for process improvements. An A3 document was updated with data and follow- up items. The PRC reported biweekly to senior leadership who supported the changes, assigned responsibilities, and approved resources and funding. Daily emails were sent from the PRC with performance feedback to all clinical departments. Results. We achieved a mean rate reduction in HA-CDI by 33.6% (P value = .02) from 6.81 (5.1-8.63) to 4.5 cases (2.86-11.84) per 10,000 patient days over a 12-month period. Antibiotic days of therapy fell by mean reduction of 6% (P value = .007) from 738 (711-760) to 696 days of therapy (679-724) per 1000 patient days. Conclusion. Many evidence-based strategies in a multipronged approach were employed to target CDI during a period of very high patient capacity. Increasing awareness and standardizing how we care for CDI patients were important strategies to decreasing the incidence of CDI. The PRC will continue to identify areas to sustain and improve CDI rates by continuous quality assurance of prevention measures and observing leading and lagging indicators over time.