341 Days Without a C. difficile Infection: How Mercy Health – St. Anne Hospital Reduced C. difficile Infection Rates to Zero

Posted on by CDC's Safe Healthcare Blog

Lisa Beauch BSN, RN, CAPA, CPAN, CIC
Lisa Beauch BSN, RN, CAPA, CPAN, CIC
Guest Author: Lisa Beauch BSN, RN, CAPA, CPAN, CIC Infection Prevention, Toledo Regional Manager Mercy Health

C. difficile (C. diff) is the most common cause of healthcare–associated diarrhea in U.S. hospitals. Reducing healthcare-acquired Clostridium difficile infections (CDIs) is a complex and evolving battle. But it’s a battle that can be won. At Mercy Health — St. Anne Hospital, a 100-bed community hospital in Toledo, Ohio, my team and I used a multi-component strategy to reduce CDI rates and from July 2016 to July 2017 successfully eliminated all healthcare-associated CDI cases.

Prior to 2015, St. Anne Hospital had 40% more infections than predicted from baseline. Aiming to improve, my team and I worked with administration at both the hospital and system level to reduce the hospital’s rate of CDI. We began by initiating a “days since last” approach on the hospital’s daily safety call. Each unit shared their daily CDI-related information including number of patients on the unit with known or suspected CDI, number awaiting specimen collection or results, and what day of hospitalization CDI was confirmed. While this call was effective in bringing CDI to the forefront of attention, more needed to be done.

In 2015, we started tracking CDI cases by their location in the hospital. This showed nearly all cases of CDI patients spent time in the ICU, so my team and I ensured each ICU room underwent additional steps in terminal cleaning using bleach and UV light. In addition, we implemented a policy that required the cleaning of suspected and confirmed CDI patient rooms with bleach, exchanging privacy curtains, and cleaning with UV light at every transfer or discharge, regardless of location. This policy also emphasized routine bleach cleaning of areas within the ICU that were prone to frequent touch such as the nurses’ station, hallway handrails, and door handles.

We educated healthcare personnel on appropriate testing, the accuracy of PCR testing, and proper specimen collection. We then implemented policies to assess for diarrhea and C. difficile risk factors at the time of admission. Patients were asked about recent antibiotic use, healthcare visits, and diarrhea. Finding patients with diarrhea and at least one other risk factor would prompt the nurse to immediately isolate the patient and obtain an order for a stool specimen. Isolation was discontinued only if C. difficile was not detected by PCR in the ordered stool specimen, or if the patient did not have watery stool in a 24-hour period. The pediatric Bristol scale helped standardize the description of stool consistency by both staff and patients.

Simultaneously, the hospital’s Infection Prevention and Pharmacy departments implemented an antimicrobial stewardship program (ASP). This program engaged both clinicians and hospital leadership such as the CEO, CMO, infectious disease physicians, and managers from departments of quality, lab, nursing, and education. The ASP staff reviewed charts for duplication of antimicrobials and de-escalation when appropriate. The use of order sets with appropriate antibiotics for diagnoses such as sepsis, community-acquired pneumonia, and UTI was encouraged for emergency department use as well as for admission orders.

The final component of the intervention involved changing contact precaution signs placed outside of CDI rooms and adding a weekly glove and gown compliance report to the safety calls. The new contact precaution signs emphasized strict adherence to the use of gowns and gloves, hand hygiene, and bleach disinfection of shared patient care items before use by another patient.

Through these efforts, my team and I were able to reduce our hospital’s expected number of CDIs to 55% less than predicted in 2016. We are delighted to report that for the first half of 2017, we had no cases of CDI at all.

For Mercy Health – St. Anne, administrative support, accountability, education, surveillance, lab reporting, adherence to proper contact precautions, antibiotic stewardship, and environmental cleaning were all the vital components of our successful CDI prevention strategy.

Lisa Beauch BSN, RN, CAPA, CPAN, CIC is the Toledo Regional Infection Prevention Manager for Mercy Health. Lisa has worked for Mercy Health for 28 years, as an Infection Preventionist since 2010 and is the current chapter president for APIC – Northwest Ohio. As of September 2017, Mercy Health St Anne Hospital was 70% below predicted number of HAI-CDI.

Mercy Health achieved 341 days without any C. Difficile Infections using these strategies https://go.usa.gov/xnghr
Posted on by CDC's Safe Healthcare Blog

21 comments on “341 Days Without a C. difficile Infection: How Mercy Health – St. Anne Hospital Reduced C. difficile Infection Rates to Zero”

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    Wonderful IP success story. I would like to ask what the EVS cleaning protocol is for bleach cleaning (liquid bleach or disposable wipes, single-use water heater mop heads or microfiber, and technique for initial bioburden removal) Additionally what type of UV disinfection was used and how was the machine utilized (daily after each terminal cleaning? or weekly in each unit?).

    Thank you Lisa . . .what an inspiring read w/all respondents statement(s) as well!
    I read your post the day after posting 02-Nov-17 as my room was being prep’d and ‘tagged’: On Contact Precautions.
    My room’s located nearly at/in the center of a 125 bed multi purpose nursing facility.
    It “seems•as•though” the ‘Power’s’ that be are only going through the motion’s to prevent the spread of hard to treat/resistant illnesses!!
    I hope your prevention plan of care makes it beyond another ‘un-funded’ State and/or Federal mandate(s), but to something that is actionable.

    Congrats! This is amazing work!! Well done! We are working on this as well. Did you utilize any type of diarrhea decision tree in this work? Would you be willing to share any ideas?

    So encouraging to hear of! I am a LPN working toward my RN license and taking Microbiology. Some of our last test’s topic has been antibiotic resistance. Great work!

    Great job. I like the weekly glove and gown compliance reporting. Antibiotic use is still discouraging as some practitioners don’t get it.

    We were excited to read your post today and the approach you took. we would also love it if you would share your policies, protocols, etc tracking forms with us as well. we are starting the process here at our 100 bed hospital

    Outstanding! Congrats to you and your team!

    Would you be willing to share your policies and procedures so that I can share them with my
    team? I’m in LTC.

    Thank you in advance

    Muy bueno. Mi hospital utilizo casi las mismas medidas con igual resultado. Solo diferimos en uso de Uv, nosotros vaporizamos con peroxido dw hidrogeno 35% al egreso.
    Buen trabajo!

    I did not perform a cost analysis specific to this project. The APIC website has a nice cost calculator on their website under the resources tab. Using that calculator I would estimate cost avoidance at nearly $150, 000 and reduction in length of stay of 66 days.

    Great and fruitful effort may I suggest repeat this policies to different HA infectious micro-organism

    Congratulations! What a team!! I would also LOVE to see your policies and the detail on the risk factors? Could you also share what electronic record you have? We use EPIC and I wonder about the order sets for this. Thanks for the inspiration!!

    Excellent work! Any precautions to limit chlorine inhalations?
    What tasks are performed by housekeeping staff?

    I wish I had had my knee surgery at this hospital. I got cd at the hospital where I had surgery. I was sick for weeks. I lost 45 pounds, my large intestine, and had to wear a colostomy bag for three months. My knee surgery was a complete success, but the hospital stay nearly killed me.

    Wonderful IP success story. I would like to ask what the EVS cleaning protocol is for bleach cleaning (liquid bleach or disposable wipes, single use mop heads or microfiber, and technique for initial bioburden removal) Additionally what type of UV disinfection was used and how was the machine utilized (daily after each terminal cleaning? or weekly in each unit?). Has there been such a success story in any larger sized institutes (500+ beds)?

    Congratulations to everyone.
    Would it be possible to use some of your policies n procedures n tracking forms to implement your program back home? ”
    Let me know as I would like to bringing to our team back in Canada tks GREAT WORK 🙂

    What an accomplishment. I hope more hospitals join the fight against CDI. Long term care facilities need help with their battles as well.

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