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War on the Spore:Clostridium difficileDisease Among Patients in a Long-Term Acute Care Hospital

Brakovich, Betsy; Bonham, Elizabeth; VanBrackle, Lewis

Journal for Healthcare Quality: May-June 2013 - Volume 35 - Issue 3 - p 15–21
doi: 10.1111/j.1945-1474.2011.00182.x
Feature Articles

The transmission of Clostridium difficile infection (CDI) is evident in healthcare facilities across the country and poses a risk for patients and communities. A comprehensive infection control program along with an active surveillance process was developed and implemented in a 50-bed long-term acute care hospital (LTACH) in the southeastern United States. Patients are admitted from surrounding hospitals, have an expected stay of at least 25 days, and are acutely ill. The majority of the patient population is ventilator dependent, immunocompromised, and treated with antimicrobials. The program, implemented in December 2009, utilized a tiered approach that included environmental cleaning and disinfection, diagnostics and surveillance, and infection control measures including antibiotic stewardship. The goal of this study was to decrease the incidence rate of CDI 15% by June 2010. Based upon year-end results, the facility achieved a 27.61% decrease in the CDI rate. During the following 12 months, the program continued to demonstrate sustainability resulting in a 23.0% decrease in the CDI rate. This program was successful in decreasing the incidence of CDI in the LTACH creating a safe and cost-effective environment for patients, families, and the community.

1 Betsy Brakovich, MPA, MSN, RN, NEA-BC is Vice President and Chief Nursing Officer for WellStar Windy Hill Hospital, Marietta, GA. Her research interests include recruitment and retention of new graduate nurses, patient safety, and quality metrics and outcomes. Betsy is a member of several professional organizations including the American Nurses Association and the American Organization of Nurse Executives.

2 Elizabeth Bonham, PhD, RN, PMHCNS, BC, is an Assistant Professor of Nursing at the University of Southern Indiana and board certified in child and adolescent psychiatric mental health nursing. Her clinical areas of interest are community-based interventions and access to care while her research interests focus on mental health issues of youthful offenders. She is a member of several professional organizations and a founding member of the International Society of Psychiatric Mental Health Nurses (ISPN).

3 Lewis VanBrackle is Professor of Statistics and Director of the Master of Science in Applied Statistics program at Kennesaw State University. His research interests are process improvement and statistical process control. He is a member of the American Society for Quality.

Received 13 July 2011; Accepted 19 October 2011

For more information on this article, contact Betsy Brakovich at

© 2013 National Association for Healthcare Quality
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