The Illinois Clostridium difficile Prevention Collaborative

Background Initiated in response to rising Clostridium difficile (C. diff) rates in Illinois hospitals Implemented jointly by Illinois Department of Public Health (IDPH) and the Illinois Quality Improvement Organization, Telligen (formerly IFMC-IL) Funded by an American Recovery and Reinvestment Act grant from the Centers for Disease Control and Prevention (CDC)

Collaborative Hospitals Metro Chicago cohort Participation period: March 2010 to September hospitals Bed size = 134 to 739 Central/southern Illinois cohort Participation period: October 2010 to September hospitals Bed size = 145 to 616

Approach Adapted from Institute for Healthcare Improvement model Multidisciplinary teams Learning sessions Action periods Model for improvement Measure and submit data Evaluate Share lessons learned

CDI Prevention Bundle  Implement hand hygiene in compliance with CDC/WHO  Place CDI confirmed patients on contact precautions in which healthcare workers wear gowns and gloves for the duration of diarrhea  Implement laboratory-based alert system for immediate notification of positive test results  Conduct education campaigns about CDI for healthcare workers, housekeepers, administration, patients and families  Environmental cleaning: Use 1:10 bleach dilution for terminal cleaning of CDI patient rooms on the targeted unit

Goals Established based on: Length of each cohort’s participation in the collaborative US Department of Health and Human Services’ goal of reducing C. diff infections (CDI) by 30% by 2013 CDI literature Targets set by other states that have implemented CDI collaboratives

Goals CDI Rates Target Hospital onset CDI incidence rate (metro Chicago cohort) 20% decrease Hospital onset CDI incidence rate (central/southern IL cohort) 15% decrease

Goals Hand hygiene, gown and glove, and environmental cleaning PracticeMonitoring of compliance on target unit Adherence rate average Hand hygiene30 observations/month90% Gown and glove30 observations/month90% Environmental cleaning5 observations/month85%

Responsibilities IDPH and Telligen Facilitate access to resources Assist with action planning Monitor team progress and provide feedback Reinforce and support adherence to best practices Facilitate sharing of successes, opportunities and lessons learned Maintain and safeguard the confidentiality of privileged information

Responsibilities Participating Hospitals Engage senior leadership Convene a multidisciplinary team on a regular basis Complete the CDI assessment tool Implement the CDI prevention bundle and set targets to achieve results Submit Lab ID, hand hygiene, and gown and glove data in CDC’s National Healthcare Safety Network monthly* Attend collaborative activities, sharing calls, and webinars Maintain and safeguard confidentiality of privileged information *Mandatory reporting of C. diff in Illinois became effective January 1, 2012, after the collaborative ended.

CDI Rates Hospital Onset CDI Rates, March September 2011 Metro Chicago Cohort (n=11)

Hospital Onset CDI Rates, March September 2011 Central/Southern Illinois Cohort (n=8) CDI Rates

Prevention Practices Adherence rates for hand hygiene and gown and glove use increased between the beginning of the participation period and the end of the collaborative period.* * Adherence rates were not reported regularly, particularly for environmental cleaning Collaborative targetChicago cohortDownstate cohort HH90%84%93% GG90%82%89% EV cleaning85%87%78% Average adherence rates over participation period

Prevention Practices Monitoring More hospitals reported meeting the collaborative targets for hand hygiene, gown and glove use, and environmental cleaning monitoring at the end of the collaborative period, compared to baseline

Evaluation survey Note: except where indicated, the results in the remaining slides are based on responses from the 18 hospitals that fully completed the evaluation survey All hospitals reported conducting a CDI education campaign or enhancing educational offerings about the prevention of CDI All hospitals reported establishing multidisciplinary CDI prevention teams

What YOU found most useful about the CDI collaborative: Having opportunities for sharing with the other hospitals Receiving assistance with education, communication, and implementation strategies Receiving support for establishing and maintaining a collaborative team Receiving support for environmental cleaning monitoring

Your recommendations for future collaboratives: Increase frequency of site visits and contact with hospital team Alternate the meeting location and organize a combined meeting for all the cohorts in the collaborative Provide clinical/content expert Provide substantive support on culture change Provide a composite or bundle of evidence-based data

Your recommendations for a CDI prevention education campaign and toolkit: Incorporate latest research Encourage involvement of all levels of the healthcare staff from leadership to the front line Support a change of culture Provide information on environmental cleaning and auditing Facilitate sharing with other facilities – tools, success stories, implementation strategies and challenges Provide information and resources on antibiotic usage Pay attention to different ways of teaching

THANK YOU for participating in the Illinois Clostridium difficile Prevention Collaborative and for taking the time to complete the surveys!