Reducing the Risks of Clostridioides difficile

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In 2015, the Centers for Disease Control and Prevention (CDC) found that Clostridioides difficile (C. diffinfection (CDI) caused almost half a million infections in a single year. A major health threat that is lethal to 14,000 patients yearly, the bacterial infection is most risky for seniors with weakened immune systems and people who are in hospitals or nursing homes for long periods.

Working with the CDC’s National Healthcare Safety Network (NHSN), two Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) worked with nursing homes to improve the reporting, measurement and elimination of these infections in health care settings.

By participating in the NHSN, nursing homes track C. diff laboratory-identified infections, admissions, treatment starts and data, including other infection prevention practices. Once in the NHSN, nursing homes can use the data to make improvements in their infection prevention policies, strengthen education for their staff and ultimately lower infection rates.

Aligning with the CDC and Centers for Medicare & Medicaid Services’ (CMS) joint goal of reducing C. diff infections 30% by 2020, the QIN-QIOs brought together a diverse group of experts and partners to support dozens of nursing homes.

How They Worked

Challenged with CDI rates that were higher than the national average, Health Quality Innovators (HQI), the QIN-QIO serving the states of Maryland and Virginia, and Alliant Quality, the QIN-QIO for Georgia and North Carolina, both started education programs in March 2017 that remain ongoing. They worked with nursing homes in their states to increase emphasis on C. diff prevention and improve the reporting of CDI to the NHSN.

HQI provided each nursing home with a detailed monthly report, allowing staff to visualize their infection rate, focus on CDI improvement goals and benchmark themselves against nursing homes across the state. 

The nursing homes with the highest 10% of reported CDI rates received one-on-one remote and on-site consultation plus infection prevention and control training, as well as coaching calls with HQI team members. In addition to cross-task events across both states to highlight and disseminate CDI-reduction resources, they also hosted monthly sharing calls and webinars, and disseminated a Do One Thing Differently” special monthly email publication for all participating nursing homes. 

HQI paid close attention to barriers communicated by nursing homes during sharing calls, webinars and on-site visits, from poor hand hygiene practices to confusion over the various types of tests available. By doing so, they were able to change their approach and target assistance as needed to provide better support, according to HQI officials.

Alliant Quality staff began monitoring nursing home facilities’ progress, and using an Excel spreadsheet and graph, they followed cohorts’ enrollment steps” to track and successfully enroll the required numbers of facilities by CDC. They followed up with the facilities on a weekly basis — and Alliant officials said much of their project’s success can be attributed to that engagement. Routine email and phone reminders, as well as formal and informal education through conference calls and webinars, all played vital roles.

The Georgia Department of Public Health and the North Carolina Department of Health and Human Services states were champions of the program as well, encouraging the nursing homes to begin enrollment. 

Since many infection-control practitioners were focused on completing the CDC Infection Control Assessment and Response (ICAR) program during these same months, this proved vital in propelling the work forward, according to Alliant.

Results

Over nine months, the nursing homes in Maryland and Virginia exceeded their 10% improvement goals, achieving a 23% relative improvement rate. They also prevented 56 C. diff infections and saved $120,000 in medication treatment costs through their work. 

With the end of the project scheduled for July 2019, the Georgia and North Carolina nursing homes continue to report CDI data into NHSN, maintaining more than the required 80% target each month, according to Alliant Quality.

Across the four states, all of the participating nursing homes actively addressing their CDI rates also reinforced overall infection prevention and antibiotic stewardship principles. The efforts additionally led to improvement in other areas, such as reducing urinary tract infection rates, improving facility safety and building capacity for sustained infection prevention in the future.