POSTER - #PI1028

Innovative and Evidence-Based Bundle Reduces Hospital-Onset C. difficile by 53%

Catherine Adamson, RN, MSN, UC Davis Health, and Julie Wardinsky, RN, BSN, CIC, UC Davis Health
UC DAVIS HEALTH - EVIDENCE-BASED PRACTICE

Background
Annually, there are 500,000 Clostridium difficile (CDI) cases and 15,000 related deaths in the United States.•UC Davis Health (UCDH), a 625 bed academic acute care hospital, exceeded internal and national hospital-onset CDI (HO-CDI) benchmarks•In 2013 there was no national standardized target. •2015: National Healthcare Safety Network (NHSN) established Standardized Infection Ratio (SIR) goal of 1.0. for HO-CDI•UCDH multi-disciplinary team developed an original CDI prevention bundle combining innovative and evidence based strategies to combat CDI•UCDH team has sustained significant reduction in HO-CDI that has evolved over a period of 5 years.

Purpose
Reduce and sustain HO-CDI in our UCDH acute care hospital to a SIR less than 1.0 to improve and save lives.

PICO Question
In the academic hospital setting, can the implementation of a multi-pronged innovative and evidence-based CDI prevention bundle decrease and maintain HO-CDI below the SIR?

Design and methods
2013-14: We launched an innovative quality improvement project designed to identify and isolate patients with asymptomatic C. difficilecolonization. These “carriers” are a known reservoir of CDI transmission. While a 20% reduction in HO-CDI was achieved, stakeholders agreed there was more work to be done. With full administrative support, a multi-disciplinary team was chartered in 2017 to “go back to the drawing board,” identify gaps in care, and develop a plan of action.

Implementation plan (See poster)

Outcomes (See poster)

Conclusions
• Combining evidence-based approaches with cutting edge strategies has led to a desirable and sustainable outcome
• Once all bundle elements were fully implemented, our HO-CDI rate and SIR decreased dramatically•We have met and sustained our improvement goals for the past seven quarters
• Beautiful job by our staff of educating our patients with an emphasis on patient safety and protection
• Our team effort, which involved nearly every hospital department, could not have succeeded without the unwavering support of our administration•Vital role of antimicrobial and diagnostic stewardship
• Home grown EMR tools led to faster, more effective tracking and intervening
• When we leverage administrative backing and break down organizational silos to effect change, our patients reap the benefit in the form of lives improved and saved

References
• Dubberke, E., & Burnham, C. (2015). Diagnosis of Clostridium difficile infection: Treat the patient, not the test. JAMA Internal Medicine, 175(11).
• McDonald, L.C., Gerding, D.N., Johnson, S., Bakken, J.S., Carroll, K.C., Coffin, S.E….Wilcox, M.H. (2018). Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA), Clinical Infectious Diseases, 66(7), e1-e48.

Funding
Gordon and Betty Moore Foundation

Acknowledgments
UCDH Patient Care Services
UCDH Infection Prevention Steering Committee
UCDH PCS Quality and Safety
UCDH Quality and Safety Clinical Affairs