Implementation of the Targeted Assessment for Prevention Strategy in a healthcare system to reduce Clostridioides difficile infection rates

• Published in: Infection control and hospital epidemiology 2020-03, Vol.41 (3), p.295-301
• Main Authors: White, Katelyn A, Soe, Minn M, Osborn, Amy, Walling, Christie, Fike, Lucy V, Gould, Carolyn V, Kuhar, David T, Edwards, Jonathan R, Cochran, Ronda L
• Format: Article
• Language: English
• Subjects: Antibiotics; Clostridioides difficile; Clostridium Infections - epidemiology; Clostridium Infections - prevention & control; Cooperative Behavior; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - prevention & control; Delivery of Health Care; Disease control; Florida - epidemiology; Health care; Health care policy; Hospitals; Humans; Incidence; Infection Control - methods; Infection Control - statistics & numerical data; Infections; Intervention; Medical laboratories; Nosocomial infections; Nursing; Participation; Prevention; Public health; Quality Improvement; Surveillance; Trends
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2019.358

Prevention of Clostridioides difficile infection (CDI) is a national priority and may be facilitated by deployment of the Targeted Assessment for Prevention (TAP) Strategy, a quality improvement framework providing a focused approach to infection prevention. This article describes the process and outcomes of TAP Strategy implementation for CDI prevention in a healthcare system. Hospital A was identified based on CDI surveillance data indicating an excess burden of infections above the national goal; hospitals B and C participated as part of systemwide deployment. TAP facility assessments were administered to staff to identify infection control gaps and inform CDI prevention interventions. Retrospective analysis was performed using negative-binomial, interrupted time series (ITS) regression to assess overall effect of targeted CDI prevention efforts. Analysis included hospital-onset, laboratory-identified C. difficile event data for 18 months before and after implementation of the TAP facility assessments. The systemwide monthly CDI rate significantly decreased at the intervention (β2, -44%; P = .017), and the postintervention CDI rate trend showed a sustained decrease (β1 + β3; -12% per month; P = .008). At an individual hospital level, the CDI rate trend significantly decreased in the postintervention period at hospital A only (β1 + β3, -26% per month; P = .003). This project demonstrates TAP Strategy implementation in a healthcare system, yielding significant decrease in the laboratory-identified C. difficile rate trend in the postintervention period at the system level and in hospital A. This project highlights the potential benefit of directing prevention efforts to facilities with the highest burden of excess infections to more efficiently reduce CDI rates.