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

Abstract

Background: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.Methods: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.Results: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).Conclusions: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.

Impact of Statewide Prevention and Reduction of Clostridioides difficile (SPARC), a Maryland public health–academic collaborative: an evaluation of a quality improvement intervention

“…However, using the TAP strategy, by focusing intensive reduction efforts where most needed, Maryland successfully reached (and surpassed) the 2020 state-wide target of 0.7 by December 2019. This approach has previously demonstrated significant decreases in C. difficile rate trends compared with a system-wide deployment 6. Given hospitals had existing hospital-acquired infection initiatives prior to SPARC, improvements in C. difficile reduction cannot be solely attributed to SPARC.…”

“…This approach has previously demonstrated significant decreases in C. difficile rate trends compared with a system-wide deployment. 6 Given hospitals had existing hospital-acquired infection initiatives prior to SPARC, improvements in C. difficile reduction cannot be solely attributed to SPARC. However, statistical methods showed acceleration of C. difficile reductions post-SPARC, and a steeper decline compared with control hospitals in the same period.…”

“…4 Together, they created the Statewide Prevention Quality improvement report and Reduction of C. difficile (SPARC) collaborative as a novel state public health-academic partnership to enhance hospital-based quality improvement (QI) efforts towards C. difficile reduction. [5][6][7][8][9][10] The objectives of this QI report are to: describe SPARC; conduct a pre-post quantitative assessment of changes in C. difficile incidence rates for SPARC intervention versus control hospitals (outcome measure); and qualitatively assess hospital perspectives of the collaborative (process measures). This paper follows the Standards for Quality Improvement Reporting Excellence reporting guidelines for QI interventions.…”

“…The Maryland Department of Health leveraged Centers for Disease Control and Prevention (CDC) Epidemiology and Laboratory Capacity funding (5 NU50CK000506-02-00), developing a partnership with two academic institutions: the University of Maryland, Baltimore, and Johns Hopkins University, both designated CDC Prevention Epicenters for infection prevention research 4. Together, they created the Statewide Prevention and Reduction of C. difficile (SPARC) collaborative as a novel state public health–academic partnership to enhance hospital-based quality improvement (QI) efforts towards C. difficile reduction 5–10…”

Assessment of public health notification thresholds for Clostridioides difficile in acute-care hospitals—Colorado and Tennessee, 2018

“…Significant reductions of CDI in hospital settings have occurred as a result of prevention initiatives, including the CDC's TAP Strategy 13 and the Core Elements Hospital Antibiotic Stewardship Programs. 14 However, at 0.72, the 2018 nationwide SIR for healthcare-facility onset CDI remains greater than the HHS 2020 action goal of an SIR of 0.5.…”