Unpacking the C. difficile infection prevention bundle

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.


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

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