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Infection Prevention Practices, Frontline Education Led to Decrease in C difficile Infections


A multifaceted approach focused on enforcing basic infection prevention practices and promoting education about Clostridioides difficile (C difficile) transmission led to a reduction in the number of infections in a hospital setting.

A series of interventions promoting frontline education about the transmission of Clostridioides difficile infections in hospital settings helped reduce cases of hospital-onset C difficile infections (HO-CDIs), according to a report published in the American Journal of Infection Control.

Cases of transmission of C difficile are often attributed to contaminated environmental surfaces, equipment, and hands. Preventive practices proven to prevent organism transmission, like proper hand hygiene (HH), appropriate use of personal protective equipment (PPE), and effective cleaning and low-level disinfection are effective in halting infection transmission. Although many health care facilities have policies stating these best preventive practices, staff, visitors, and patients are often unaware of them.

To promote education about these practices and reduce HO-CDIs and C difficile transmission, investigators from Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, implemented a multifaceted approach involving a new laboratory testing policy, enhanced cleaning and disinfection of patient rooms, and antibiotic stewardship practices to reduce the use of high-risk antibiotics. The approach implemented educational practices for just-in-time staff, visitors, and patients and infection preventionist (IP) observations of HH and PPE, as well as monitored the use of appropriate isolation precautions.

All inpatients with an active C difficile infection were identified through positive tests, oral vancomycin reports, and line-listing techniques that made it so mitigation strategies can be implemented as early as possible to prevent transmission.

After a patient with CDI was identified, HH with soap and water and PPE compliance at their respective inpatient location were monitored. An infection prevention tracer also was completed, which examined mitigation protocol, including appropriate isolation order, visible posting of the contact precautions sign, PPE availability, proper use of PPE, HH compliance, and staff knowledge on C difficile policies for cleaning and low-level disinfection.

Education often happened simultaneously with observation to ensure timely feedback was provided to staff, the investigators noted. The IP met with the patient’s unit and care team and had a brief conversation about caring for a patient with CDI, answering any questions about C difficile policies. Patients and visitors also received a CDC patient educational handout on C difficile, as well as a patient and visitor educational handout detailing preventive strategies they could take while at the facility.

After the implementation of C difficile transmission interventions, the investigators observed a 36% decrease in cases of HO-CDIs in fiscal year 2018 (49 C difficile events) compared with fiscal year 2017 (77 C difficile events). They also observed a 41% decrease in their respective HO-CDI standardized infection ratio, from 1.10 to 0.65—which was significantly lower than the national benchmark in 2 of the quarters in fiscal year 2018. Additional reductions were seen in fiscal year 2019 (43 C difficile events).

When implementing preventive measures against health care–associated infections like C difficile, the importance of basic infection prevention principles such as HH, isolation precautions, use of PPE, and cleaning should not be overlooked, the authors note.

Providing staff, visitors, and patients with frontline education and feedback about the transmission of C difficile is critical for prevention and management of the infectious disease in health care settings.


Read ME, Olson AJ, Calderwood MS. Front-line education by infection preventionists helps reduce Clostridioides difficile infections. Am J Infect Control. 2020;48(2):227-229. doi:10.1016/j.ajic.2019.08.002

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