Preventing C. difficile in Massachusetts Hospitals with a Mixed-Methods Learning Collaborative

The Massachusetts CDI Prevention Collaborative focused on the following activities:

• Emphasized engaging frontline staff in identification of barriers and solutions
• Used improvement frameworks (e.g., Model for Improvement) and culture change strategies (e.g., Positive Deviance)
• Organized three statewide, full-day learning and sharing workshops, as well as regional workshops featuring expert presentations and highlighting accomplishments of collaborative participants
• Established a listserv, with regular communication with team leaders and coaching as needed
• Used uniform measurement and reporting tools

Program impact was assessed by examining rates of hospital-acquired CDI over time. Comparing four baseline months (Jan–April 2010) and the most recent four months (Sept–Dec 2011), the collaborative achieved an overall 25% decrease in hospital-acquired CDI (8.88 to 6.70 per 10,000 patient days).

Changes in cleaning and disinfection (71%), lab test ordering (71%), and contact precautions (57%) were reported most frequently by the 17 hospital infection prevention specialists who completed a post-program survey (68% response rate). Education was the most frequently used approach for practice improvement (81%), followed by engaging frontline staff in conversations about infection prevention (75%), and sharing data (69%). Additionally, more than half of respondents reported improving communication, engaging leadership, empowering frontline staff, using small tests of change, and developing new policies.

Lessons learned from the collaborative include the following:

• Engaging multidisciplinary teams that represent all levels of staff is needed to drive improvement.
• Using improvement and engagement frameworks, which support adapting changes to local needs, helps promote improvements and culture shifts; education alone does not work.
• Balancing delivery of expert content with valuable lessons that participants share (all teach, all learn) is vital.
• Having a clear aim and using shared data to track changes and motivate improvement is powerful.
• Obtaining leadership support is essential, and includes actively engaging with the team, promoting a culture that allows innovation and failure as part of ongoing improvement work, and allocating resources to implement documented improvements when needed.
• Building on previous initiatives and statewide collaborations is important.
• Planning for a two-year program is valuable, since change takes time and participants come at various stages of readiness.