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A Multifaceted Approach to the Prevention of Clostridioides (Clostridium) Difficile

Pate, Kimberly, MSN, RN, ACCNS-AG, PCCN; Reece, Jennifer, BSN, RN; Smyre, Alex, BCJ

doi: 10.1097/NUR.0000000000000426
Feature Article

Purpose/Objectives The purpose of this project was to design and implement a sustainable program to reduce hospital-acquired cases of Clostridioides difficile.

Description of the Project Experiencing higher rates in a large, academic medical center, hospital leaders were assembled. The overall facility rate was 6.9% in 2014 with a first quarter rate of 8.4% in 2015. Individual unit rates were as high as 19.8%. A team of key stakeholders was assembled to plan, execute, and reevaluate targeted solutions. Strategies implemented were an innovative, automated screening tool, an evidence-based prevention bundle; and staff education.

Outcomes A facility-wide C difficile prevention program was implemented with a sustained decrease in rates observed from 8.4% in the first quarter of 2015 to 6.0% in the fourth quarter of 2017. The standardized infection ratio ranged from 0.541 to 0.889, consistently below the national mean.

Conclusion Clostridioides difficile is a leading cause of hospital-associated diarrhea and a tremendous burden on healthcare systems increasing morbidity, mortality, and financial strain. A multidisciplinary, multifaceted approach was critical to ensure early detection, reduce risk of transmission, and decrease overall rates.

Author Affiliations: Clinical Nurse Specialist, Surgical-Trauma Division (Ms Pate), Infection Preventionist (Ms Reece), and Data Analyst, Infection Prevention (Ms Smyre), Carolinas Medical Center, Charlotte, North Carolina.

No funding was received for this quality initiative.

The authors report no conflicts of interest.

Correspondence: Kimberly Pate, MSN, RN, ACCNS-AG, PCCN, 1000 Blythe Blvd, Charlotte, NC 28203 (

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