ISR 13 - Implementing Data-Driven Quality Improvement Initiatives to Reduce Hospital-Onset Clostridioides difficile Infection Standardized Infection Ratio in an Acute Care Hospital

Background: Healthcare-associated infections (HAIs) represent a significant source of preventable morbidity and mortality. During the 2019 fiscal year (July 2018 through June 2019), we witnessed a 63% spike in the standardized infection ratio (SIR) of Hospital-Onset Clostridioides difficile infections (HO-CDIs). We conducted a study to identify and reduce the frequency and cumulative impact of quality metric opportunities affecting HO-CDI SIR in a 395-licensed-bed acute care hospital.

Methods: Our team conducted a case series study that spanned four years, focusing on patients who met National Healthcare Safety Network (NHSN) Laboratory Identified Event (LabID) HO-CDI criteria within the current fiscal year. We analyzed 42 HO-CDI cases using a Root Cause Analysis (RCA) to identify missed opportunities related to essential quality metric controls and external patient factors. We used statistical software to create Pareto Charts highlighting the process measures that required the most attention.

Results: Six prominent opportunities contributing to HO-CDIs among the patients emerged in the analysis: following standard work, laxative use within 24 hours of specimen collection, stooling documentation, clinical indications for testing, prompt use of precautions with symptoms, and a specimen slip. We implemented quality improvement initiatives and visual auditing tools that targeted these six vital process measures, including updates and access to standard work, Grand Rounds with providers, and two-step deoxyribonucleic acid (DNA) and Toxin testing. Utilizing these tools significantly reduced our hospital's SIR from 1.165 to 0.897 in the first year, to 0.691 in the second year, and finally to 0.330. Overall, we achieved a 71.674% reduction in HO-CDI SIR.

Conclusions: This study confirms that continuous identification, analysis, and targeted preventative maintenance effectively decrease HO-CDI SIR. Furthermore, these findings underscore the importance of ongoing efforts to improve hospital practices and procedures supported by data to prevent the spread of infections and reduce HAIs and SIRs to enhance patient care and health outcomes.