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March 27, 2018

The 3-step plan that drove one hospital's C. diff infection rate to zero

Daily Briefing

    Editor's note: This popular story from the Daily Briefing's archives was republished on Aug. 13, 2019.

    Stillwater Medical Center in Oklahoma hasn't had a hospital-acquired Clostridium difficile (C. diff) infection since October 2017, Jennifer Thew writes for HealthLeaders Media, largely due to a multifaceted approach led by Necia Kimber, an infection control practitioner at the hospital.

    Cheat sheet: Understand the Hospital-Acquired Conditions Reduction Program

    Kimber said the hospital's C. diff infection rate wasn't extraordinarily high to begin with, but even so, she wanted "to mak[e] sure we were doing the best we could."

    Here are three steps that Kimber implemented to help Stillwater drive down its C. diff infection rates.

    1. Educate providers, including explaining when—and when not—to order C. diff tests

    Kimber helped lead an education campaign on C. diff, including teaching nurses and physicians how to implement various C. diff precautions.

    The education also included explaining national standards for when it's appropriate to order C. diff tests. "(As health care professionals), when you have a patient and you can't find anything with normal testing, we tend to expound our testing," said Kimber.

    But sometimes, an aggressive approach to testing leads to false positives: "(I)f (the patient) tested positive for (C. diff, it) didn't mean they were actually infected with it," Kimber explained. "They can just be colonized with it."

    2. Hygiene, hygiene, hygiene

    A key step was placing an even greater emphasis on hand hygiene, according to Kimber. Each month, the hospital asked "secret shoppers" to observe their unit's hand hygiene and report back. "What we check for is hand hygiene upon entering the room and upon leaving the room," said Kimber.

    Not only that, but nurses and physicians were required to clean their hands before entering a new room, even if they already had cleaned their hands after leaving the previous room, to reinforce hand hygiene practices.

    Stillwater also began using a bleach-based product to clean rooms and equipment after patients are discharged. "We used to only (use bleach) on positive C. diff rooms," said Kimber. "Now we use it on all rooms because there are so many people who are carriers and not showing signs (of infection) until after they've been discharged."

    3. Bring on the ultraviolet robots

    According to Kimber, when Stillwater purchased new pulsed xenon ultraviolet robots to aid in sterilization, they finally drove their C. diff rates down to zero.

    "I've been an infection control nurse for almost 18 years," Kimber said, "and I'd never seen a drop as dramatically as I had in C. diff after implementation of the UV robots."

    Kimber acknowledged that the robots can be expensive, estimating that each one costs around $100,000. But she said, "By national standards one C. diff infection is about $30,000 when you look at morbidity and length of stay. For surgical-site infection, if it's a hip or a knee, you're getting into the hundreds of thousands."

    She added, "So, for example, with surgical-site infections if you could just save one surgical-site infection—say a hip or a knee—you've already saved $100,000, so your ROI will be pretty quick in knocking your infection rates down" (Thew, HealthLeaders Media, 3/6).

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