Preparing for the Future: Implementing a Comprehensive Clostridium difficile Management Program at the Point of Care

2.50
Hdl Handle:
http://hdl.handle.net/10755/183153
Category:
Abstract
Type:
Presentation
Title:
Preparing for the Future: Implementing a Comprehensive Clostridium difficile Management Program at the Point of Care
Author(s):
Kruedelbach, Georgine; Lawrence, C.
Author Details:
Georgine Kruedelbach, RN, BSN, CEN, Lee Memorial Health System/Cape Coral Hospital, Cape Coral, FL, email: Georgine.kruedelbach@leememorial.org; C. Lawrence
Abstract:
Purpose: The purpose of this evidence-based practice program was to pilot surveillance for Clostridium difficile Infection (CDI) according to the Centers for Disease Control and Prevention (CDC) criteria and to pilot a CDI care bundle to reduce and contain CDI in compliance with The Joint Commission?s new 2010 National Patient Safety Goal (NPSG). CDI is a bacterial infection that causes diarrhea and prolonged ileus, toxic megacolon, bowel perforation, and death. CDI-associated deaths have risen from 5.7 per million population in 1999 to 23.7 per million population in 2004. CDI can increase length of stay by 2.8 days with an associated cost of $5,000 per hospitalization and places patients at risk for long-term care. Readmission rates can approach 19%. CDI surveillance is problematic because it is often difficult to determine exact exposure as CDI symptoms often do not occur for weeks after an exposure and spores can live for months outside the human body. The 2010 NPSG requires hospitals to institute multidrug resistant risk assessment, establish surveillance, institute evidence-based prevention interventions, and educate hospital staff. Additionally, processes and outcomes of CDI measures should to be reported to key stakeholders and a laboratory based alert system implemented. Centers for Medicare and Medicaid Services have targeted CDI as a potentially non-reimbursable healthcare-associated condition. Method: Using the CDC's case definitions for CDI, a decision-making tree (algorithm) was developed and piloted at a community hospital in Southwest Florida. Using the algorithm, a 6-month retrospective chart review was conducted to determine pre-intervention total CDI rates and Healthcare Facility Onset- Healthcare Facility Associated (HO-HCFA) CDI rates per 10,000 patient days. An evidence-based practice CDI care bundle was piloted at the point of care and included: contact isolation for all patients with diarrhea, isolation signage, removal of alcohol hand hygiene product, computerized isolation alert, and terminal bleach clean. Targeted hospital staff completed a self-study CDI education module and attended a presentation by the infection preventionist. A 3-month prospective chart review for CDI rates was conducted to determine intervention success. Findings: Over 60% of targeted staff received CDI bundle and surveillance education. Total CDI rates decreased from 23 per 10,000 patient days to 20 per 10,000 patient days post-implementation. HO-HCFA CDI rates decreased from 7 per 10,000 patient days to 4 per 10,000 patient days. HO-HCFA real time surveillance has now been adopted at the community hospital and implemented at three additional acute-care hospitals in the healthcare system. Discussion: This program set out to meet the NPSG and reduce CDI occurrence. The care bundle was effective in reducing CDI rates. However, the bundle may not solely be responsible for the decrease in CDI rates as hand hygiene and contact isolation compliance also increased during the intervention period. CDI rates were reported to hospital stakeholders and as a result, more rapid and accurate laboratory diagnostics have been purchased. Consequently, stakeholders are regularly apprised of CDI rates and trends. CDI prevention, early identification, and transmission reducing interventions can be accomplished through evidence-based practice implemented at the point of care.
Repository Posting Date:
28-Oct-2011
Date of Publication:
28-Oct-2011
Conference Date:
2010
Conference Name:
7th Annual Florida Magnet Research Conference
Conference Host:
University of South Florida College of Nursing; Sigma Theta Tau International; Florida Organization of Nurse Executives
Conference Location:
Naples, Florida, USA
Description:
7th Annual Florida Magnet Research Conference - Theme: Research at the Point of Care. Held 11-13 February 2010 at the Naples Grande Beach Resort, Naples, Florida, USA.
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titlePreparing for the Future: Implementing a Comprehensive Clostridium difficile Management Program at the Point of Careen_GB
dc.contributor.authorKruedelbach, Georgineen_US
dc.contributor.authorLawrence, C.en_US
dc.author.detailsGeorgine Kruedelbach, RN, BSN, CEN, Lee Memorial Health System/Cape Coral Hospital, Cape Coral, FL, email: Georgine.kruedelbach@leememorial.org; C. Lawrenceen_US
dc.identifier.urihttp://hdl.handle.net/10755/183153-
dc.description.abstractPurpose: The purpose of this evidence-based practice program was to pilot surveillance for Clostridium difficile Infection (CDI) according to the Centers for Disease Control and Prevention (CDC) criteria and to pilot a CDI care bundle to reduce and contain CDI in compliance with The Joint Commission?s new 2010 National Patient Safety Goal (NPSG). CDI is a bacterial infection that causes diarrhea and prolonged ileus, toxic megacolon, bowel perforation, and death. CDI-associated deaths have risen from 5.7 per million population in 1999 to 23.7 per million population in 2004. CDI can increase length of stay by 2.8 days with an associated cost of $5,000 per hospitalization and places patients at risk for long-term care. Readmission rates can approach 19%. CDI surveillance is problematic because it is often difficult to determine exact exposure as CDI symptoms often do not occur for weeks after an exposure and spores can live for months outside the human body. The 2010 NPSG requires hospitals to institute multidrug resistant risk assessment, establish surveillance, institute evidence-based prevention interventions, and educate hospital staff. Additionally, processes and outcomes of CDI measures should to be reported to key stakeholders and a laboratory based alert system implemented. Centers for Medicare and Medicaid Services have targeted CDI as a potentially non-reimbursable healthcare-associated condition. Method: Using the CDC's case definitions for CDI, a decision-making tree (algorithm) was developed and piloted at a community hospital in Southwest Florida. Using the algorithm, a 6-month retrospective chart review was conducted to determine pre-intervention total CDI rates and Healthcare Facility Onset- Healthcare Facility Associated (HO-HCFA) CDI rates per 10,000 patient days. An evidence-based practice CDI care bundle was piloted at the point of care and included: contact isolation for all patients with diarrhea, isolation signage, removal of alcohol hand hygiene product, computerized isolation alert, and terminal bleach clean. Targeted hospital staff completed a self-study CDI education module and attended a presentation by the infection preventionist. A 3-month prospective chart review for CDI rates was conducted to determine intervention success. Findings: Over 60% of targeted staff received CDI bundle and surveillance education. Total CDI rates decreased from 23 per 10,000 patient days to 20 per 10,000 patient days post-implementation. HO-HCFA CDI rates decreased from 7 per 10,000 patient days to 4 per 10,000 patient days. HO-HCFA real time surveillance has now been adopted at the community hospital and implemented at three additional acute-care hospitals in the healthcare system. Discussion: This program set out to meet the NPSG and reduce CDI occurrence. The care bundle was effective in reducing CDI rates. However, the bundle may not solely be responsible for the decrease in CDI rates as hand hygiene and contact isolation compliance also increased during the intervention period. CDI rates were reported to hospital stakeholders and as a result, more rapid and accurate laboratory diagnostics have been purchased. Consequently, stakeholders are regularly apprised of CDI rates and trends. CDI prevention, early identification, and transmission reducing interventions can be accomplished through evidence-based practice implemented at the point of care.en_GB
dc.date.available2011-10-28T16:16:49Z-
dc.date.issued2011-10-28en_GB
dc.date.accessioned2011-10-28T16:16:49Z-
dc.conference.date2010en_US
dc.conference.name7th Annual Florida Magnet Research Conferenceen_US
dc.conference.hostUniversity of South Florida College of Nursingen_US
dc.conference.hostSigma Theta Tau Internationalen_US
dc.conference.hostFlorida Organization of Nurse Executivesen_US
dc.conference.locationNaples, Florida, USAen_US
dc.description7th Annual Florida Magnet Research Conference - Theme: Research at the Point of Care. Held 11-13 February 2010 at the Naples Grande Beach Resort, Naples, Florida, USA.en_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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