Clostridium difficile (CDI) - a priority healthcare-associated infection

CDI Gap Analysis

The Clostridium difficile Infection (CDI) Prevention Strategies - Gap Analysis includes a checklist of core and enhanced prevention strategies. Core prevention strategies should always be in place. Examples include:

• Provide patient/family education.
• Ongoing CDI surveillance.
• Early identification of patients with suspect CDI.
• Isolation precautions
• Clean and disinfect patient rooms and patient care equipment.
• Implement an antimicrobial stewardship program.
• Documentation practices.

Enhanced prevention strategies should be considered in addition to core strategies when there is evidence of:

• Core strategies not being implemented and adhered to consistently
• Ongoing transmission of CDI
• CDI rates not decreasing
• Change in CDI pathogenesis (e.g., increased morbidity/mortality among CDI patients)

Tools for CDI Road Map Topics - Supporting CDI Reduction   

Use these sample tools as templates and to take action in your organization.

Patient and Family Education

Indications

Insertion - Insertion practices

Maintenance - Maintenance practices

Removal - Removal practices

Documentation - Documentation practices

General Resources

Sample Tools - Apply/Take Action

Clostridium difficile Infections (CDI) Toolkit. A health care provider’s guide to preventing clostridium difficile infections, developed by the Oklahoma Foundation for Medical Quality and Stratis Health. This toolkit is a compilation of evidence-based research and guidelines, recommendations, tools, and resources to be used in work on CDI prevention. (26-page Word doc)

. The Minnesota Hospital Association, funded by CMS’s Leading Edge Advanced Practice Topics, has compiled two Controlling CDI tool kits: Controlling CDI Hand Hygiene and Controlling CDI Environmental Cleaning Training and Supervision.

. This toolkit assists hospital staff and leadership in developing an effective antimicrobial stewardship program with the potential to reduce C. difficile. An antimicrobial stewardship program is a systematic approach to developing coordinated interventions to reduce overuse and inappropriate selection of antibiotics, and to achieve optimal outcomes for patients in cost-efficient ways.

Professional Education and Training

. In 2014, Approximately 83,000 of the patients who developed C. difficile experienced at least one recurrence and 29,000 died within 30 days of the initial diagnosis. This webinar discusses targeting and implementing CDI prevention strategies in the acute care settind. (55-minute video)

. This webinar, presented on September 17, 2013, by Susan Kellie MD, MPH, hosted by the Great 8+ QIO Group, illustrates how to:

• Identify recent changes in the epidemiology of C. difficile Infection (CDI) including transmission and risk populations
• Describe evidence based best practices involved in a multi-faceted approach to prevention of CDI
• Recognize the problem areas in CDI prevention and discuss possible solutions

References/Guidelines/Standards

. This guideline is designed to improve the diagnosis and management of Clostridium difficile infection (CDI) in adult patients. A case of CDI is defined by the presence of symptoms (usually diarrhea) and either a stool test positive for C. difficile toxins or toxigenic C. difficile, or colonoscopic or histopathologic findings revealing pseudomembranous colitis. In addition to diagnosis and management, recommended methods of infection control and environmental management of the pathogen are presented. The recommendations are based on the best available evidence and practices, as determined by a joint Expert Panel appointed by SHEA and the Infectious Diseases Society of America (IDSA) (the SHEA-IDSA Expert Panel). Published in Infection Control and Hospital Epidemiology 2010; 31 : 431-455 "Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA)"

. Compendium of infection prevention recommendations for acute care hospitals by the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA). Published in Infection Control and Hospital Epidemiology 2008 Oct;29 Suppl 1:S81-92.

Patient Education

. Patient brochure with frequently asked questions and answers from the Infection Control Professionals of Southern New England. (2-page PDF)

. Questions and answers CDI fact sheet from a coalition of national infection prevention organizations. (1-page PDF)

. Questions and answers CDI fact sheet in Spanish from a coalition of national infection prevention organizations. (1-page PDF)