After 1 year, HO-CDI incidence dropped 63% from baseline, from above 12 cases per 10,000 patient-days to 4.72 per 10,000 patient-days. And after 3 years, infections dropped 77% to 2.80 per 10,000 patient-days.
The hospital’s HO-CDI standardized infection ratio – the total number of infections divided by the National Healthcare Safety Network’s risk-adjusted predicted number of infections – dropped below the national benchmark, from 1.11 in 2015 to 0.43 in 2020.
The hospital also increased testing of appropriate patients for CDI within the first 3 days of admission, from 54% in 2014 to 81% in late 2019.
“By testing patients within 3 days of admission, we discovered that many had acquired C. diff. before admission,” Ms. Walter said. “I don’t think we realized how prevalent C. diff. was in the community.”
Benjamin D. Galvan, MLS(ASCP), CIC, an infection preventionist at Tampa General Hospital and a member of the Association for Professionals in Infection Control and Epidemiology, welcomed the study’s results.
“Effective collaboration within the health care setting is a highly effective way to implement and sustain evidence-based practices related to infection reduction. When buy-in is obtained from the top, and pertinent stakeholders are engaged for their expertise, we can see sustainable change and improved patient outcomes,” Mr. Galvan, who was not involved in the study, said in an email.
“The researchers did a fantastic job,” he added. “I am grateful to see this important work addressed in the literature, as it will only improve buy-in for improvement efforts aimed at reducing infections moving forward across the health care continuum.”
Douglas S. Paauw, MD, a professor of medicine and chair for patient-centered clinical education at the University of Washington School of Medicine, Seattle, said that the team’s most important interventions were changing the environmental cleaning protocol and using agents that kill C. diff. spores.
“We know that as many as 10%-20% of hospitalized patients carry C. diff. Cleaning only the rooms where you know you have C. diff. (isolation rooms) will miss most of it,” said Dr. Paauw, who was also not involved in the study. “Cleaning every room with cleaners that actually work is very important but costs money.”
Handwashing with soap and water works, alcohol hand gels do not
“We know that handwashing with soap and water is the most important way to prevent hospital C. diff. transmission,” Dr. Paauw noted. “Handwashing protocols implemented prior to the study were probably a big part of the team’s success.”
Handwashing with soap and water works but alcohol hand gels do not, he cautioned.
“C. diff. rates in hospitals went up years ago when we started putting alcohol gels outside patients’ rooms,” Dr. Paauw explained. “Now, instead of washing their hands, staff quickly pump gel before they see patients. Applying gel is easy, but gel does not eliminate C. diff. spores. Handwashing is such a simple way to fix the C. diff. problem, but doctors don’t take the time.”
“We need to take the C. diff. problem seriously. We have enough information, and we know the right things to do. We need to wash our hands. We need to clean the rooms. We need to stop cutting corners if we want to give good care,” he said.
The authors plan to conduct further related research.
The study was not funded. All study authors, as well as Mr. Galvan and Dr. Paauw, have reported no relevant financial interests.
A version of this article first appeared on Medscape.com.