Reviewed by Dr. Michael Payne, MD, London Health Sciences Centre 

Reviewed by Zach Willis, MD, MPHD, University of North Carolina School of Medicine and Erica Stohs, MD, MPH, University of Nebraska Medical Center  

Reviewed by Vanessa Stevens, PhD, University of Utah and Rebekah Moehring, MD, MPH, FSHEA, Duke University 

Reviewed by Hannah Imlay, MD, MS, University of Utah 

Reviewed by James “Brad” Cutrell, MD, FIDSA, UT Southwestern Medical Center 

Reviewed by Erica Stohs, MD, MPH, University of Nebraska Medical Center 

Reviewed by Clare Marlin, MS, BSN, CIC, Shirley Ryan AbilityLab and Erica Stohs, MD, MPH, University of Nebraska Medical Center 

Reviewed by Cynthia T. Nguyen, PharmD, University of Chicago Medicine and Vanessa Stevens, PhD, University of Utah 

Reviewed by Dr. Michael Payne, MD, London Health Sciences Centre

Reviewed by Hannah Imlay, MD, MS, University of Utah

Reviewed by Zachary Willis, MD, MPH, University of North Carolina Health Care

Reviewed by Shaefer Spires, MD, Duke University School of Medicine and James “Brad” Cutrell, MD, UT Southwestern Medical School

Reviewed by Michael Payne, MD, London Health Sciences Centre and Erica Stohs, MD, MPH, University of Nebraska Medical Center

Reviewed by Cynthia T. Nguyen, PharmD, University of Chicago Medicine 

Reviewed by Clare Marlin, MS, BSN, CIC; Shirley Ryan AbilityLab 

Reviewed by Hannah Imlay, MD, MS, University of Utah Health 

Reviewed by Emily Thorell, MD, MSCI University of Utah Health and Zachary Willis, MD, MPH University of North Carolina School of Medicine

Blanco and colleagues recognized a gap in examination of the effectiveness of individual components of C. difficile infection (CDI) reduction bundles. In this quasi-experimental study implemented at two acute care community hospitals in Maryland, the authors studied a CDI bundle from a statewide CDI reduction initiative that was created with multidisciplinary support from the hospitals involved, including expertise from Infectious Diseases, Pharmacy, Environmental Services, and Informatics.  Aligning with this bundle implementation, the authors piloted computerized clinical decision support-based (CCDS) interventions, which focused on providing patient-specific data to clinicians through electronic medical records (EMR) at the point-of-care and decision making.  The five components of this CDI reduction bundle were: Timely placement of enteric precautions; Decision support at the time of electronic ordering; Reducing proton-pump inhibitor (PPI) use; Reducing the use of antibiotics which contribute to increased risk of CDI (e.g. fluoroquinolones); Optimizing the use of sporicidal agents for environmental cleaning. The interrupted time series analysis identified that a CDI reduction bundle had variable effects on CDI reduction-related measures depending on the hospital’s local context and variable implementation and promotion of specific bundle components. For example, one hospital had a 75% decrease in hospital onset CDI post-implementation, likely driven by reductions in CDI testing especially for patients on laxatives; the other hospital failed to see a change in hospital onset CDI or testing rates using the same bundle components but different CCDS implementation. The authors conclude that ongoing vigilance with evaluating both clinical outcomes and process measures of individual infection reduction bundle components can inform quality improvement.

Reference:

Blanco N,et al. Impact of a C. difficile infection (CDI) reduction bundle and its components on CDI diagnosis and prevention. American Journal of Infection Control 2021; 49: 319-326.

Reviewed by Rebekah Moehring, MD, MPH, FSHEA, Duke University

Reviewed by Emily Thorell, MD, MSCI, University of Utah Health, Salt Lake City, UT and Zachary Willis, MD, MPH, University of North Carolina School of Medicine, Raleigh, NC