Combating C. Diff: Building a bundle to reduce the transmission of healthcare onset Clostridium difficile infections

Dawn Engels, MSN, RN, CWOCN, CWCN-AP, CNS1, Tamara Caple, MSN, RN, MBA, NEA2, Barbara Deskins, MSN, RN-BC3, Connette Gill, MSN, RN4, Danyel Johnson, MSN, RN, CNN, CNS5, Melissa Morgan, MSN, RN, CIC, CSPDT6 and Margaret Steelman, BSN, RN6, (1)CNS/WOC Department, Cone Health System, Greensboro, NC, (2)Medical-Renal department, Cone Health System, Greensboro, NC, (3)Clinical Support/Nursing Administration, Cone Health System, Greensboro, NC, (4)Medical-Renal Department, Cone Health System, Greensboro, NC, (5)Cone Health System, Greensboro, NC, (6)Infection Prevention, Cone Health System, Greensboro, NC
Clostridium difficile infections (CDI) are a significant safety issue and impact patient morbidity and mortality. Prevention of Healthcare Onset Clostridium difficile infections (HOCDI) transmission has become a top priority for healthcare organizations. In an effort to decrease HOCDIs within our organization, an interprofessional team collaborated to develop a CDI Prevention Bundle. Bundle methodology has demonstrated success in decreasing healthcare associated infections such as central line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonia (VAP). Bundles standardize practices and ensure evidence-based care. The CDI Prevention Bundle contains specific interventions to address patient screening on admission and/or when symptoms first appear, appropriate timely disinfection of the environment, equipment and supplies, patient/family education in CDI transmission prevention and hand hygiene practices. Extensive efforts were made to ensure the bundle could be integrated into the daily workflows of nursing staff. An inpatient nursing unit was selected to pilot the project. Staff nurses were instrumental in providing constructive feedback to make the necessary adjustments which would ensure successful execution. Modifications occurred over several months after interventions were trialed.  After rigorous auditing and consulting with nursing staff on the pilot unit, a final CDI Prevention Bundle was established and ready for organization-wide implementation. The process of creating a CDI Bundle provided an opportunity for many disciplines to work together towards a valuable goal; keeping patients safe from harm during their hospitalization. Collaboration between physicians, infection prevention specialists, clinical nurse specialists, WOC nurses, environmental services, and nurses resulted in a process that will impact length of stay, mortality, and patient satisfaction. As with all bundles, this CDI initiative is multi-faceted and multi-tiered. Audits will assess compliance with use of the new system. The facility will assess if a reduction in HOCDI rates is achieved by comparing monthly CDI rates to pre-bundle rates to determine if there is a decrease.