Multidisciplinary Task Force Cdiff Project Infection Preventionist Administration Environmental Services Personnel Registered Nurses Physicians Pharmacy Project Facilitator

The Clostridium difficile (Cdiff) project was initiated as a hospital-wide priority when hospital associated incident rates were high in Hospital acquired Cdiff was defined in 2009 as a new positive toxin test greater than 48 hours from admission date. The 2009 hospital acquired Cdiff incidence rate was An initial target of a 10% (22.74) reduction was set. The plan for 2010 was to work in decreasing our hospital acquired Cdiff incidence rate using a step wise plan. Selection & Purpose

Cdiff Project Analysis Cdiff task force decided on 3 main focuses: Environmental Cleaning Broad Spectrum Antibiotic Use Standardization of Clinical Care of Cdiff Patients

Solutions The specific solutions in the 3 main focuses, environmental cleaning, broad spectrum antibiotic use and standardization of clinical care of Cdiff patients, were as follows: Environmental Cleaning – Laundry water temperatures adjusted – Microfiber cloths were added to cleaning equipment (more cloths/larger items) – Dedicated toilet scrubbers stored in bleach – Twice a day bathroom cleaning of Cdiff isolation rooms. – “ 2 HAIs too many” = 3 day course of bleach cleaning – Once per week cleaning with bleach in the ICU – Decluttering of isolation patient care area – Proper use of bath basin – Additional sinks were added in the ICU – Isolation and hand hygiene fall outs were provided immediate feedback Pharmacy – Chart reviews of all HAI cases – PPI tracking in relation to HAI infections Clinical Care of Cdiff patient – Cdiff order set – Authority policy for RN to send 1st Cdiff test without physician order – Improvement of specimen collection and transport

Hospital Acquired Cdiff Housewide Quarterly Incidence Rate per 10,000 Patient Days