Establishing a Collaborative to Prevent Healthcare-Associated Clostridium difficile Infection in Illinois Hospitals

Background: Nationally, 30,000 people die each year from Clostridium difficile infection (CDI), a healthcare-associated infection (HAI). Rates of CDI among patients discharged from Illinois hospitals increased from 4.5 per 1,000 discharges in 1999 to 9.9 per 1,000 discharges in 2009. Among 1.6 million hospital discharges in Illinois, 15, 323 cases of CDI were reported.

The Department of Health and Human Services (HHS) has set a five year target to reduce CDI case rates in the United States by 30%. To prevent CDI transmission among patients in Illinois hospitals, the Illinois Department of Public Health implemented a C. difficile Prevention Collaborative, with a goal of reducing healthcare-associated (HA) CDI by 20%. This is the first effort of the Illinois Department of Public Health to use a collaborative model to reduce a HAI in acute care hospitals.

Methods: Eleven acute care hospitals voluntarily enrolled in a 19-month collaborative (March 1, 2010-September 31, 2011). Selection was based on CDI rates in hospital discharge data, interest, and commitment from senior leaders. All facilities implement a core bundle of CDI prevention practices. Multidisciplinary teams are formed to identify gaps between best practice and current practice and to implement the CDI bundle. While all hospitals implement a core set of strategies, each facility may decide to adopt additional prevention strategies. Small tests of change are piloted on a target patient care unit.

Participants measure CDI using CDC's surveillance system, the National Healthcare Safety Network. To measure process improvements, participants conduct hand hygiene, contact precautions, and environmental cleaning observations.

Aggregate CDI incidence rates are analyzed by comparing sequential 3 month periods beginning with the baseline period (March-May 2010). Degree of participation in collaborative activities is monitored for each facility.

Results: The HA CDI incidence rate decreased from the baseline period to the second time period by 8.9%. The HA CDI incidence rate increased by 1.7% from the second time period to the third time period. Hospitals with high participation rates in collaborative activities experienced a 9% decrease in HA CDI rates; hospitals with low participation experienced a 4% decrease. Hand hygiene and contact precaution adherence rates increased from 81% and 85% in August 2010 to 89% and 87% in November 2010, respectively.

Discussion: Public health agencies have a role in reducing HAIs. Reductions in CDI have occurred since initiation of the CDI prevention collaborative, and are associated with degree of facility participation in collaborative activities.