Doreen McSharry, RDH, MA, CIC, CHSP, Jeffrey M. Raskin, MD, Aaron A. Stein, MD, Rose Lee, PharmD, Vinay Yalamanchi, DO, Frank Lopez, DO, Joel Chandy, DO
Palisades Medical Center, North Bergen, NJ
Introduction: The prevalence of hospital-acquired Clostridioides difficile infection (CDI) in a healthcare facility is directly correlated with the efficacy of infection prevention practices. Although associations are well documented between CDI incidence and the exposure to antibiotics and acid-reducing medications, to effectively prevent CDI, all risk factors for transmission must be investigated. This study will demonstrate how innovative practice strategies, created by a multidisciplinary CDI Prevention Team, that were introduced and sustained over a 20 month period of time, resulted in dramatic improvements in CDI rates.
Methods: A cohort of 52 patients with a diagnosis of CDI were chosen for the purpose of determining the efficacy of an innovative, multi-disciplinary intervention. The subject lists were obtained from the NHSN reported cases. The study was comprised of three phases: Pre-intervention Period, Transitional Period, and Intervention Period. During the Transitional Period, the innovative, multidisciplinary intervention was introduced, consisting of a series of preventive strategies aimed at eradicating CDI in the patient population and the hospital’s physical environment.
Results: Of the 52 patients studied with CDI, 23 patients were Community-Onset while 29 patients were Hospital-Acquired. With each study period, CDI HAI’s were shown to decrease as the innovative practice strategies were incorporated into practice. In fact, during the Pre-intervention Period, there were 17 HAI’s with 9461 patient days resulting in a 1.79 infection rate; the Transitional Period, 6 HAI’S/ 14,697 patient days resulting in a 0.40 infection rate; and the Intervention Period, 6 HAI’s/33,603 patient days resulting in a 0.17 infection rate. In summary, the annual CDI rate decreased by 62% over one year after implementation of multidisciplinary interventions, demonstrating a statistically significant trend of reducing the infection rates. (P value < 0.0001).
Discussion: The data analysis identified well-known CDI risk factors that included residing in long-term care institutions, acid suppressive therapy, prior antibiotic use and the management of the patient's environment. The incorporating of a variety of strategies such as: hand washing, isolation precautions, electronic medical record features, diagnostic testing parameters, UV technology, disposable meal trays, cutlery and plates, and managing the patient's environment, could serve as a paradigm for reducing CDI in a Community-based hospital.
Citation: Doreen McSharry, RDH, MA, CIC, CHSP, Jeffrey M. Raskin, MD, Aaron A. Stein, MD, Rose Lee, PharmD, Vinay Yalamanchi, DO, Frank Lopez, DO, Joel Chandy, DO. P1014 - INNOVATIVE PRACTICE STRATEGIES FOR PREVENTING CLOSTRIDIOIDES DIFFICILE (CDI) IN A COMMUNITY-BASED HOSPITAL. Program No. P1014. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.