Strategies to Reduce

Hospital-Acquired
Clostridioides difficile
Alexis Hsu, Angela Schiltz,
Kelsey Ehmann, Leila Rosin, &
Payton Pavlicek
Tucson Medical Center
● Tucson, Arizona
● Unit Chosen: Unit 500 Cardiac Acute
Care at TMC
● Unit Demographics:
○ Post-CABG & Post-VAT with chest
tubes
○ 12-lead EKG & Telemetry
○ Arrythmia
○ Med-surg
○ Patient Population: 18+
○ 30 Bed Unit
○ Daily census: 27-30 patients
○ Staffing: 5-7 nurses, 2-3 PCTs
○ Flat organization structure
○ Interdisciplinary team
■ Unit manager,
Charge/Clinical Nurse Lead,
Nurses
■ Doctors and Consultants
■ RTs, Lab, Pharmacy, PT/OT
■ Unit clerk, PCTs
■ Wound care
(Hobbs + Black ■ Housekeeping
Architects, n.d.)
 Quality Improvement Issue
Why did we choose this issue?
Issue for Improvement:
TMC’s data shows that HA-C.
difficile infection (HA-CDI)
rates were between 0.64-0.73
To reduce the spread of
in the past 12 months. TMCs
hospital-acquired
goal for 2023 was 0.52 (TMC
Clostridioides difficile
Quality Scorecard, 2024).
(HA-C. difficile)
Patients with C. difficile have
been reported to have an
increased length of stay by at
least 3 days (Sepsis Alliance,
2020).
Current actions taken by the
unit to improve performance
related to the issue:
● Hand sanitizer stations
around the unit with
built-in sensor tracker
● Gloves and masks
available in every
patient’s room
● Contact precaution
signs and PPE on
doors when needed
 Model for Improvement: Forming the Team
Charge nurses monitor
staff hand-washing
Nurse educators instruct Charge Nurse habits and reminds
the staff on the increased them to practice hand
spread of C. difficile and hygiene.
utilize EBP to teach the Nurse Educator
team about hand
hygiene and early signs RNs practice
of C. difficile. appropriate hand
RN Staff hygiene and use PPE
PCTs will wash hands when needed. RNs will
frequently after coming notice early signs of C.
Patient Care
in contact with feces or difficile.
Techs
other body fluids of any
patient.
Model for Improvement: Setting Aims

AIMS Sta tem ent:

Reduce Clostridiodes difficile infections to less than 0.52
Standardized Infection Rate (SIR) every quarter in TMC
Cardiac Acute Care Unit 500 within 12 months of
implementing a C. difficile protocol (Turner & Anderson,
2020).

AIMS to improve include: Safety, efficiency, timeliness,

effectiveness, and accessibility.
Mod el for Im p rovem ent: Esta b lishing Mea sures
● Quality Improvement Measured by:
○ Ra te of CDIs: ( Num b er of new
hosp ita l- a cq uired ca ses of C.
d ifficile) / ( Tota l num b er of
p a tient d a ys in the m onth) x
10 0 0
● Unit d a ta :
○ 2 0 2 3 YTD ra te of CDIs: 4 .5 1
since Ma rch 2 0 2 3
● Na tiona l b enchm a rk:
○ 0 .3 74 0 CDI La b ora tory-
Id entified Events for a g enera l
a cute ca re hosp ita l ( CDC,
2024)
 Model for Improvement: Selecting
Cha ng es
1.Improve Hand 2 . Im p rove RN 3 . Im p rove correct
Hygiene Compliance: hig h- touch conta ct p reca utions for
For prevention against clea ning p er shift: p a tients with C. difficile :
C. difficile Use designated start of Use correct contact
transmission: Scan each RN shift to do high- precautions of gown and
badge at sink to track touch cleaning at nursing gloves with all C. difficile
use (Turner & Anderson, station and first patient patient contact for RNs,
2020). contact for in-patient PCTs, and visitors (Turner
room high touch & Anderson, 2020, & Scaria
Selected for cleaning (Doll et al., et al., 2021).
PDSA. 2020).
 Model For Change: Testing Changes

PLAN DO STUDY ACT

P D S A

● Objective ● Implementation ● Evaluation after

● Adapt, adopt, or
● Engage ● Tracking 12 months of
abandon
Stakeholders ● Document implementation
● Establish problems/unexp ● Objective met?
Protocol ected ● Address what
● Training/Educat observations was learned
ion ● Next steps
● Prediction

(IHI, n.d.)
Model For Change: Testing Changes

● Objective:
PLAN ○ Reduce C. difficile among hospitalized patients in the
Cardiac Acute Care unit by implementing a badge
P tracking soap and water hand washing system
● Engage Stakeholders
● Objective ○ 2-3 week planning period to discuss changes, gain
● Engage support, and determine construction time
Stakeholders ● Establish Protocol
● Establish Protocol ○ Consult nursing staff and infectious disease specialists
● Training/Education ● Training and Education
● Prediction ○ Mandatory 1-week online course
○ Mandatory in-person training
● Predictions
○ Decrease yearly C. difficile infection rates
○ Improve hand hygiene (Turner & Anderson,
○ Pushback from nurses 2020)
Model For Change: Testing Changes

DO ● Implementation
○ On unit 500, require nurses to take the 1-week online
education course
D ○ Have nurses sign up for available in-person training
sessions
● Implementation ○ Install sinks
● Tracking ○ Set up badge scanner tracker
● Document ○ Identify and resolve any challenges faced within one
problems/unex week of implementation
pected ● Tracking
observations ○ Analyze weekly data of each nurse
○ Continuous tracking of C. difficile patients
○ Allow for daily nurse feedback
○ Evaluate data within 3 months of implementation
● Document problems/unexpected observations (Turner & Anderson,
2020)
Model For Change: Testing Changes

● Evaluation of data after 12 months of implementation

STUDY ○ Compile the daily/weekly hand-wash badge scanning
compliance from the 12-month implementation
S ○ Compile results of C. difficile rates before and after
implementation
○ Compare the data and results to our predictions
● Evaluation of ● Objective met?
data after 12 ○ After 12 months of implementation of the badge scanning
months of system for soap and water hand washing, was there a notable
implementation reduction in C. difficile rates?
● Address what was learned
● Objective met?
● Next steps
● Address what
○ Communicate findings
was learned ○ Modifying implementation for continuous improvement
● Next steps ○ Expand the soap and water hand hygiene badge scanning
(Turner &
system Anderson,
○ Continue monitoring compliance data and outcomes 2020)
POTENTIAL BARRIERS

BARRIERS SO LUTIO NS

Ba rrier 1: Solution 1:
Perform a nce The average cost of C. difficile
( Costs) to the hospital outweighs the
cost of installing 4 new sinks
in each unit.
Ba rrier 2 : Sta ff Solution 2 :
Focus ( Nurse Incentives of monthly food
Resista nce) parties and presenting
nurses with unit statistics.

(Reveles et al., 2023; Zhang et al., 2016)

Objective: Reduce CDI among hospitalized patients in the Cardiac
Acute Care unit by implementing a badge-tracking soap and water
hand-washing system for patients with CDI
Engage Finalize Protocol: Training and
Stakeholders: every Consult nursing staff Education: 1-week
2-3 weeks to discuss and infection online and in-person
with staff specialists training
Implement: Require the 30-bed Cardiac Required Personnel:
unit to utilize a badge-tracking soap and Policy Support: Charge nurse and nurse
water hand-washing system for all patients educator
with CDI over the next 12 months CDI Protocol Team: Staff RN and PCTs

3 Month -Was the objective

Track Data (soap & water
Eval: 12 Month met?
badging compliance, CDI
Nurse Eval -What challenges
rate, length of stay, etc.)
feedback were faced?
Communicate findings:
Modify implementation for continuous improvement to ensure bundle
success and reduction in the C. difficile rates
Expand soap and water hand hygiene badge scanning system to other units
Continue monitoring compliance data and outcomes
References
Centers for Disease Control and Prevention [CDC]. (2021). CDI prevention strategies.
https://www.cdc.gov/cdiff/clinicians/cdi-prevention-strategies.html
Centers for Disease Control and Prevention. (2022). FAQs for clinicians about C. diff.
https://www.cdc.gov/cdiff/clinicians/faq.html
Centers for Disease Control and Prevention. (2024). The NHSN standardized infection ratio (SIR).
https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sir-guide.pdf
Doll, M. Marra. A. R., Apisarnthanarak, A., Saif Al-Maani, A., Abbas, S., & Rosenthal, V. D. (2020).
Prevention of Clostridioides difficile in hospitals: A position paper of the International Society of
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 References
Hobbs + Black Architects. (n.d.). Tucson Medical Center West Pavilion [Online image].
https://www.hobbs-black.com/tmc-west-pavilion
Institute for Healthcare Improvement [IHI]. (n.d.). Model for improvement: Testing changes.
https://www.ihi.org/resources/how-to-improve/model-for-improvement-testing-changes
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