Helping Frontline Staff Reduce Clostridioides difficile Infections with an Automated Report

Session Description: Beginning in June 2023, a 191-bed community hospital sought to understand why Clostridioides difficile (C.difficile) rates increased in 2022 and 2023 despite interventions that had been successful in prior years. Following many discussions with frontline team members, it was determined that there was a lack of understanding surrounding the National Healthcare Safety Network (NHSN) Laboratory Identified (LabID) C.difficile definitions despite frequent coaching provided by Infection Prevention Specialists.

To bridge this education gap, Infection Prevention (IP) created an automated report in the electronic medical record (EMR) to mimic their daily C.difficile pending lab review process. The process was originally developed for IP to review all pending C.difficile labs for testing appropriateness. The goal of this report was to help frontline team members understand testing appropriateness from an IP’s point of view without having to rely on memory recall of the LabID definition. The report included variables such as actual calendar day count, admission date, collection date, lab status, order status, and the last three documented stool consistencies. A train-the-trainer approach was used to teach nurse managers how to interpret the report. Once trained, nurse managers could run the report for their specific unit at any time to identify pending labs, identify team members accountable to the C.difficile ordering and collection process. The report facilitated knowledge regarding if C.difficile orders were appropriate, if samples were collected correctly, and if there was any delay in C.difficile sample collection. Nurse managers could then provide one-on-one coaching on common staff errors such as delayed stool sample collection, inappropriate ordering, and lack of documentation. Concurrently, IP provided targeted education on this process during weekly rounds and at skills fairs.

The creation of this report has led to a substantially decreased C.difficile rate in 2024 and a more streamlined communication process between frontline staff members and IP.