For the past three quarters, we have seen a sustained improvement in the rate of hospital-acquired C. Difficile infections (CDI) at Englewood Hospital. For 2019, our year-to-date standardized infection ratio is 0.457, down from 1.141 from our 2018 rate.
In early 2018, a multidisciplinary CDI Prevention Committee was initiated in response to an increase in the rate of CDI. The committee analyzed infection prevention and control practices, laboratory testing processes, provider prescribing patterns, and staff knowledge and education related to CDI. An evaluation of published guidelines and literature review on the subject was performed by the clinical members of the CDI team.
This analysis identified the following opportunities:
- Antibiotic prescribing patterns, which included a high utilization of fluoroquinolones.
- Highly sensitive laboratory testing algorithm including reflex PCR testing was identifying patients with chronic colonization as acute infection.
- Repeat laboratory testing of stool samples and testing patients on laxatives were contributing to false positives.
- All staff required education and updating on transmission-based precautions and CDI prevention.
- There was a need to standardize, monitor, and improve the adequacy of environment and equipment cleaning.
The following measures were implemented:
- Fluoroquinolone restriction
- Revision of C. Difficile testing algorithm
- Enhanced education from the infection prevention team and residents to all floors on hand hygiene.
- Epic BPA to reduce testing of patients on laxatives and repeat testing.
- Review of cleaning practices and education of environmental staff.
Despite significant progress, continued vigilance is required to sustain this success. We ask for the continued support of all physicians to be role models and leaders in infection prevention and control.