A quality improvement project in a large medical intensive care unit successfully reduced Clostridioides difficile infection rates and testing. The initiative aimed to lower both the positivity rate of Clostridioides difficile polymerase chain reaction (PCR) tests and the number of tests ordered, comparing preintervention data (July 2017 to December 2019) with postintervention outcomes (January 2021 to December 2022). Interventions included standardizing supply carts, introducing oral care kits, adding new signage for enteric precautions, educating staff and visitors, providing patient scripting, and implementing a Clostridioides difficile testing algorithm.
Results showed a 66% reduction in positive Clostridioides difficile PCR tests, decreasing from 34.9 to 12.3 per 10,000 patient days. The number of PCR tests ordered dropped by 44%, from 28 to 15.7 per 1,000 patient days. These clinically significant improvements highlight the effectiveness of quality improvement tools like A3, Gemba walks, and plan-do-study-act cycles. The project demonstrates that similar initiatives can reduce patient harm, enhance care, and improve outcomes in other healthcare settings.
Reference: Barker L, Gilstrap D, Sova C, et al. Reducing Clostridioides difficile Infections in a Medical Intensive Care Unit: A Multimodal Quality Improvement Initiative. Dimens Crit Care Nurs. 2024 Jul-Aug 01;43(4):212-216. doi: 10.1097/DCC.0000000000000644. PMID: 38787778.
