Study: Interprofessional Collaboration Reduces Incidence of Hospital-Onset C. Difficile


Infections at community hospitals fell by 63% after 1 year and 77% after 3 years, new data show.

Health care facilities can significantly reduce the incidence of hospital-onset Clostridioides difficile infection (HO-CDI) by establishing interprofessional teams to implement evidence-based, selected infection-prevention intervention, according to the results of a study published in the American Journal of Infection Control.

“Our project showed that interprofessional collaboration and continuous improvement can profoundly impact HO-CDI incidence and sustain reductions over years,” Cherith Walter, MSN, RN, from Emory St. Joseph’s Hospital, said in a statement. “We hope our findings will help other health care teams struggling with this incredibly challenging health care-associated infection to improve patient safety and reduce associated costs.”

Walter and other investigators creased an interprofessional team to address the HO-CDI incidence at their 410-bed community hospital, which was consistently about the national CMS benchmark of C. difficile. The interprofessional team comprised an antimicrobial stewardship pharmacist, a clinical microbiologist, a clinical nurse specialist, an environmental service representative, a hospital epidemiologist, an infection preventionist, a physician champion and unit nurse champions.

The team revived the HO-CDI events at their facility between 2014 and 2016 to determine causative factors.

Additionally, they identified appropriate, evidence-based infection prevention interventions, which comprising diagnosis stewardship, including the development of a Diarrhea Decision Tree (DDT) testing algorithm with a nurse-driven ordering protocol; education and accountability, focusing on encouraging compliance with the DDT algorithm; and enhanced environmental cleaning, antimicrobial stewardship, including a system-wide electronic medical record intervention to reduce fluoroquinolone use.

After the first year, the investigators recorded a 63% decrease in HO-CDIs compared with the 2 years prior, which amounted to about 4.72 per 10,000 patient days and 12 per 10,000 days, respectively.

Additionally, the number improved further, showing 2.8 per 10,000 days after 3 years of implementation of the selected interventions, which was a 77% decrease from the baseline.

The investigators also saw a decrease in the facilities standardized HO-CDI infection ratio, which is the total number of infections divided by the National Health Safety Network’s risk-adjusted predicted number of infections. That decreased to 0.43 in 2020 from 1.11 in 2015.

The interventions also improved CDI testing practices, increased testing for appropriate patients within the first 3 days of hospital admission to 81.1% in late 2019 from 54% in 2014 to support prompt treatment of individuals who are infected.

The practice also helped identify and differentiate cases of community-acquired CDI from HO-CDI, which reduced the financial impact of HO-CDIs on the facility after 2016.

Finally, investigators successfully increased compliance with the algorithm from 50% in mid-2018 to 80% in mid-2020, which they said happened because of empowering nurses to hold physicians accountable for judicious test ordering and creating a system of accountability notices that alerted nurses and physicians to DDT algorithm deviations.

“These study findings are exciting, because they suggest that professional collaboration to consistently apply known, evidence-based practices can significantly reduce the incidence of HO-CDI,” Linda Dickey, RN, MPH, CIC, FAPIC, and 2022 president of Association for Professionals in Infection Control and Epidemiology, said in the statement. “They are also the first findings demonstrating the impact of education and accountability interventions in reducing HO-CDI incidence and improving compliance with standards of practice.”.


Interprofessional collaboration leads to significant and sustained reduction in hospital-onset c. difficile infections. EurekAlert. News release. May 12, 2022. Accessed May 12, 2022.

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