Team Effort Significantly Reduces Hospital-Onset C-difficile Infections


The interprofessional team implemented multiple evidenced-based interventions that demonstrated sustained compliance.

By instituting interprofessional teams to implement evidence-based infection-prevention interventions, health care facilities can demonstrably reduce the incidence of hospital-onset Clostridioides difficile (C-difficile) infection (HO-CDI). of the new study, “Interprofessional Collaboration Leads to Significant and Sustained Reduction in Hospital-Onset C. Difficile Infections,” published in the American Journal of Infection Control (AJIC),”

The lead author, Cherith Walter MSN, RN, APRN, AGPCNP-BC, AGCNS-BC, clinical nurse specialist at Emory Saint Joseph's Hospital of Atlanta, and her colleague also involved in the study, Tanushree Soni, PhD, MPH, CIC, infection prevention coordinator of Emory Healthcare Systems, spoke to Infection Control Today® (ICT®) about their results and their upcoming research around this topic.

To address the HO-CDI incidence at their 410-bed community hospital, Walter and Soni, and their colleagues created an interprofessional team involving a clinical nurse specialist, a physician champion, a hospital epidemiologist, an infection preventionist, a clinical microbiologist, unit nurse champions, an antimicrobial stewardship pharmacist, and an environmental services representative. After reviewing HO-CDI events at their facility between 2014 and 2016 to determine causative factors, the team then identified appropriate, evidence-based infection prevention interventions.

“The cornerstone of [the study] was this testing algorithm, which we called 'The Diarrhea Decision Tree (DDT),'” Walter told ICT® in an exclusive interview. “We had a nurse-driven protocol, [that required] in those first 3 days—that community-acquired timeframe—nurses could autonomously test any loose or unformed stool. Then [we used] some evidence-based criteria for how the nurses would test stool starting at day 4 and after.“

The investigators achieved their objective to reduce HO-CDI. “The main goal of this [study was] to identify the infections early on, so that the patients could get the right treatment. andbe isolated so that we could prevent the transmission to other patients. Patient Safety was our first goal. And we used the diagnostics because we wanted to empower our nurses.”

The investigators emphasized that the study was a team effort. “The team today has been amazing, and it takes all of us together,” Walter said.

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