Impact of a C. difficile infection (CDI) reduction bundle and its components on CDI diagnosis and prevention

• Published in: American journal of infection control Vol. 49; no. 3; pp. 319 - 326
• Main Authors: Blanco, Natalia, Robinson, Gwen L., Heil, Emily L., Perlmutter, Rebecca, Wilson, Lucy E., Brown, Clayton H., Heavner, Mojdeh S., Nadimpalli, Gita, Lemkin, Daniel, Morgan, Daniel J., Leekha, Surbhi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2021
• Subjects: Antibiotic resistance; Computerized clinical decision support; Hospital infection control; Hospital infection control; Computerized clinical decision support; Antibiotic resistance
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2020.10.020

•A C. difficile Infection reduction bundle showed variable impact.•A 75% decrease in hospital-associated C.difficile infection post-implementation was observed for one of the hospitals•Processes and intermediate outcomes should be critically evaluated and deconstructed Published bundles to reduce Clostridioides difficile Infection (CDI) frequently lack information on compliance with individual elements. We piloted a computerized clinical decision support-based intervention bundle and conducted detailed evaluation of several intervention-related measures. A quasi-experimental study of a bundled intervention was performed at 2 acute care community hospitals in Maryland. The bundle had five components: (1) timely placement in enteric precautions, (2) appropriate CDI testing, (3) reducing proton-pump inhibitor (PPI) use, (4) reducing high-CDI risk antibiotic use, and (5) optimizing use of a sporicidal agent for environmental cleaning. Chi-square and Kruskal-Wallis tests were used to compare measure differences. An interrupted time series analysis was used to evaluate impact on hospital-onset (HO)-CDI. Placement of CDI suspects in enteric precautions before test results did not change. Only hospital B decreased the frequency of CDI testing and reduced inappropriate testing related to laxative use. Both hospitals reduced the use of PPI and high-risk antibiotics. A 75% decrease in HO-CDI immediately postimplementation was observed for hospital B only. A CDI reduction bundle showed variable impact on relevant measures. Hospital-specific differential uptake of bundle elements may explain differences in effectiveness, and emphasizes the importance of measuring processes and intermediate outcomes.