HSHS St. John’s Hospital – Springfield, Illinois
Our hospital saw a continuous increase in hospital-onset Clostridium difficile infections (CDI) averaging nearly 10 per month over the course of a calendar year, with a high of 18 cases in one month. Upon reviewing all the factors involved, our team set a goal of reducing the number of hospital-onset cases by 50% by implementing a dramatic process change in our CDI testing protocol.
All orders for C. difficile testing after calendar day three are held until a review is performed by a multi-disciplinary team, including Infection Prevention, Pharmacy, Infectious Disease, and Nursing. The goal of this review is to assess the appropriateness of testing, which includes a review of the patient’s history of CDI, recently used and current medications and CDI-related symptoms. The team ensures that all providers involved in the care of a particular patient understand the entire clinical picture to ensure excellent quality outcomes and antimicrobial stewardship. After implementing this practice change, our hospital saw a 78% decrease in hospital-onset CDI over the course of one year for our entire hospital, with an estimated cost savings of over $600,000.
While spreading this intervention through the innovation challenge in 2018 we found there were some important characteristics which led to successful high impact implementation:
Must Have:
- A strong need for change related to CDI prevention
- At least 1.0 FTE dedicated infection preventionist
- Lab support, including a timely list of all pending C. difficile orders (e.g. via IP surveillance platform)
- A method to reach providers directly on a daily basis
- Strong administrative/executive buy-in
Should Have:
- Specific time set aside to perform review daily without interruption
- Good relationship between doctors and infection preventionists
- Nursing educator
- Appropriate testing methodology—rapid, on-site with a separate C. difficile test (not panel)
- Knowledge of your daily CDI testing volume
- ID Pharmacist and/or pharmacy support
- IP surveillance platform
Could Have:
- ID Physician Champion
- Antimicrobial Stewardship Program
- Schedule of when C. difficile tests are run by lab (batched certain time)
- IT: Meditech, Epic, Theradoc
Please complete the form below to recieve a copy of the HSHS St. John’s implementation playbook: