1. The call The happy years The awakening Work to do Michelle Bushey, RN, BS, BSN, CIC Director Infection Prevention and Patient Safety

2.  “Clostridium difficile is on the rise, and if you are not seeing an increase in your hospital, your hospital needs to evaluate its testing methods.” ◦ (Dr. B. Miller, 5 th Decennial International Conference on Healthcare Associated Infections, March 2010)

3.  At Bon Secours St Francis in Greenville, we had tracked C. difficile for many years.  formalized expanded enteric precautions and  improved compliance with hand hygiene and use of PPE, our C. difficile rate had decreased.  In FY 2010, SF initiated a formal antibiotic stewardship committee.  We evaluated risk factors: could we predict which patients would acquire C. difficile based on patient profile.

5.  PCR testing begins Oct 1, 2011  Immediately, 3x more identified  By year end, 41% increase in number (75 to 127)  By year end, rate per pt 1000 pt day had increased from 0.15 – 0.36 (58% increase!)

6.  Better identification  Better contact precautions  Better Environmental Cleaning  Better Communication

7.  MD approved protocol for C. difficile testing for patients who admit via Emergency Department with ongoing diarrhea.

8. ◦ Any patient with diarrhea is placed on isolation and tested. ◦ Laminated signs directing staff and family members to use soap and water were placed on alcohol dispensers in patient’s rooms if the patient was identified with C. difficile.

9. ◦ Purchased sodium hypochlorite (bleach) wipes. All RNs instructed to wipe patient equipment with bleach wipe if patient is identified with diarrhea. ◦ Bleach wipe holders were placed in each patient’s room so HCWs would have the tools they need for cleaning. ◦ Housekeeping now cleans all rooms after discharge with bleach and any patient on enteric contact precautions with bleach. ◦ Removed patient privacy curtains from non ICU and ED rooms. Door knock signs were placed outside each patient’s door. ◦ Collaboration with Environmental Services for ATP testing in inpatient rooms with immediate feedback to the appropriate housekeeper. Results are shared with Administration and with EVS staff.

10. Each month Infection Prevention shares C. difficile infection specifics with the St Francis Clinical Transformation team. Team members include the CMO, CNE, Administrative Directors of Acute Care and ICU Nursing, ED, Quality and Pharmacy.

11. At 0.27 our rate is still almost double of what we believed to be true in 2010, but happily, we feel we are moving in the right direction.