Leveraging Quality Improvement Science to Reduce C. difficile Infections in a Community Hospital

Lambl, Barbara B.; Altamimi, Sarah; Kaufman, Nathan; Rein, Mitchell S.; Freeley, Monique; Duram, Maureen; Krauss, Wendy; Kurowski, Janice; O'Neill, William; Seeley, Paul; Gagnon, Mary Jo; Phillips, Duncan E.; Rubin, Marc

doi:10.1016/j.jcjq.2018.10.006

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…We found clinically significant reductions in the rate of CDI cases and PCR tests ordered. These findings are comparable to others who also found a reduction in CDI cases when using QI methodologies and strategies 14,15 . Similar to our findings, Sperling and colleagues 16 found a reduction in the rate of C. diff tests ordered after implementing diagnostic stewardship interventions to optimize testing for CDI.…”

Section: Discussionsupporting

confidence: 91%

“…These findings are comparable to others who also found a reduction in CDI cases when using QI methodologies and strategies. 14,15 Similar to our findings, Sperling and colleagues 16 found a reduction in the rate of C. diff tests ordered after implementing diagnostic stewardship interventions to optimize testing for CDI. Appropriate testing plays an important role in identifying true CDI cases and further supports antimicrobial stewardship efforts.…”

Section: Discussionsupporting

confidence: 86%

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Reducing Clostridioides difficile Infections in a Medical Intensive Care Unit

Barker,

Gilstrap,

Sova

et al. 2024

Dimens Crit Care Nurs

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Background Clostridioides difficile (C. diff) infection causes significant morbidity for hospitalized patients. A large medical intensive care unit had an increase in C. diff infection rates. Objectives The aim of this project was to reduce the C. diff polymerase chain reaction (PCR) test positivity rate and the rate of C. diff PCR tests ordered. Rates were compared between preintervention (July 2017 to December 2019) and postintervention (January 2021 to December 2022) timeframes. Methods Unit leadership led a robust quality improvement project, including use of quality improvement tools such as A3, Gemba walks, and plan-do-study-act cycles. Interventions were tailored to the barriers identified, including standardization of in-room supply carts; use of single-packaged oral care kits; new enteric precautions signage; education to staff, providers, and visitors; scripting for patients and visitors; and use of a C. diff testing algorithm. Statistical process control charts were used to assess for improvements. Results The average rate of C. diff PCR test positivity decreased from 34.9 PCR positive tests per 10 000 patient days to 12.3 in the postintervention period, a 66% reduction. The average rate of PCR tests ordered was 28 per 1000 patient days in the preintervention period; this decreased 44% to 15.7 in the postintervention period. Discussion We found clinically significant improvements in the rate of C. diff infection and PCR tests ordered as a result of implementing tailored interventions in a large medical intensive care unit. Other units should consider using robust quality improvement methods and tools to conduct similar initiatives to reduce patient harm and improve care and outcomes.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 86%

Reducing Clostridioides difficile Infections in a Medical Intensive Care Unit

Barker,

Gilstrap,

Sova

et al. 2024

Dimens Crit Care Nurs

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“…Our study adds important depth to the existing literature regarding QI initiatives aimed at reducing HCFO CDI through combinations of diagnostic stewardship, prevention bundles, electronic health record clinical decision support, and real-time monitoring. [15][16][17] With rates of CDI colonization estimated to be as high as 8.1% in asymptomatic patients with previous hospitalization and up to 50% in patients admitted from long-term care facilities, promoting increased diagnostic stewardship is an essential endeavor to avoid morbidity associated with unnecessary antibiotics. 5,6,18 Additionally, treating asymptomatic C difficile colonization through overdiagnosis imposes significant economic burden on patients and hospitals alike.…”

Section: Discussionmentioning

confidence: 99%

Reduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative

Zaver

Moktan

Harper

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…Thus, hospitals have begun to focus on quality improvement (QI) interventions to encourage providers to improve quality of care [ 3 ] and patient outcomes [ 4 ]. QI aims to improve patient care [ 5 ] and provide a systematic approach to effect change through stepwise process and outcome analysis [ 6 , 7 ]. Healthcare professionals have tried structural interventions to improve the care process, and consequently, the health outcomes [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Healthcare Quality Improvement Analytics: An Example Using Computerized Provider Order Entry

et al. 2021

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Evaluation of sustainability after quality improvement (QI) projects in healthcare settings is an essential part of monitoring and future QI planning. With limitations in adopting quasi-experimental study design in real-world practice, healthcare professionals find it challenging to present the sustained effect of QI changes effectively. To provide quantitative methodological approaches for demonstrating the sustainability of QI projects for healthcare professionals, we conducted data analyses based on a QI project to improve the computerized provider order entry system to reduce patients’ dosing frequencies in Korea. Data were collected for 5 years: 24-month pre-intervention, 12-month intervention, and 24-month post-intervention. Then, analytic approaches including control chart, Analysis of Variance (ANOVA), and segmented regression were performed. The control chart intuitively displayed how the outcomes changed over the entire period, and ANOVA was used to test whether the outcomes differed between groups. Last, segmented regression analysis was conducted to evaluate longitudinal effects of interventions over time. We found that the impact of QI projects in healthcare settings should be initiated following the Plan–Do–Study–Act cycle and evaluated long-term effects while widening the scope of QI evaluation with sustainability. This study can serve as a guide for healthcare professionals to use a number of statistical methodologies in their QI evaluations.

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Leveraging Quality Improvement Science to Reduce C. difficile Infections in a Community Hospital

Cited by 7 publications

References 29 publications

Reducing Clostridioides difficile Infections in a Medical Intensive Care Unit

Reducing Clostridioides difficile Infections in a Medical Intensive Care Unit

Reduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative

Healthcare Quality Improvement Analytics: An Example Using Computerized Provider Order Entry

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