New York Hospitals Team Up to Reduce Clostridium difficile Infections

Using standardized data collection tools, hospital teams collected and submitted data, including elements to measure C. difficile infection (CDI) rates and compliance with the prevention bundle and environmental protocol. Reports containing hospital-specific and aggregate peer-group comparison results were provided to hospitals. Hospitals submitted monthly data to the Clostridium difficile Collaborative until December 2009. New York State Department of Health began collecting these data through the CDC’s National Healthcare Safety Network in July 2009 for public reporting. Meetings and conference calls guided collaborative activities and allowed hospitals to share successes and barriers. Site visits to most hospitals were made, often with the physician chair, to identify best practices and implementation challenges.

Thirty-five hospitals were included in the analyses; 21 were teaching hospitals (60%).

• Hospitals achieved a statistically significant reduction in hospital-associated CDI rates from 10.7 to 8.6 per 10,000 patient days (p <0.001).
• On average, there was a 20% reduction in hospital-associated CDI among facilities submitting sufficient data for analysis.
• Slight decreases in the non-facility-associated; community-onset, hospital-associated; and recurrent CDI rates were found over time, but all three were not statistically significant.

Based on a regression estimation, hospitals had 1,084 fewer cases of hospital-onset CDI than expected. Applying published estimates of costs attributable to C. difficile, total cost savings were estimated at $2.7 million to $6.8 million.

• Initiation of a sustainable infection control program requires administrative and clinical leadership support, multidisciplinary teamwork, and ongoing communication. To help redefine the hospital’s approach to infection prevention, the initiative based its interventions on the collaborative model and a “team approach.” The model expanded infection control and patient safety responsibilities beyond infection control practitioners to all clinicians, administrative staff, and non-traditional departments (e.g., environmental and transport services departments).
• Data collection was time consuming for the hospitals in the collaborative. Several teams experienced difficulties with collecting environmental data, emphasizing the importance of environmental services supervisors’ involvement from the beginning of this initiative.
• The patient placement strategy was difficult for some hospitals, because of the physical layout and the limited number of private rooms in some hospitals.