Employing the Model for Improvement to Reduce Clostridium difficile

Background: The 1000 Lives Campaign in Wales aims to save 1000 Lives and prevent 50,000 episodes of harm during the 2 year campaign from April 2008 to April 2010. A key part of the campaign is the Healthcare Associated Infection (HCAI) content area which aims to contribute to the overall campaign by reducing mortality and morbidity due to all causes of HCAI using evidence based interventions. Within Cardiff and Vale University Health Board it was decided to use the HCAI content area work to target a reduction in Clostridium difficile disease.

Objective: To employ the model for improvement of the 1000 Lives campaign to firstly pilot interventions to reduce C. difficile on three wards and then spread the work across the organisation to reduce C. difficile disease across the organisation.

Methods: Three wards with high levels of C. difficile disease were engaged in the pilot work. Three key areas of intervention were chosen: Cleaning / decontamination; Hand hygiene and antimicrobial use. Cleaning and decontamination included work to de-clutter the ward environment, and development of improved processes for cleaning commodes and beds as well as the general ward environment. Hand hygiene teaching supported improvements in hand hygiene, antimicrobial use was improved both in terms of the treatment of C. difficile cases and also general antimicrobial use on the ward. Plan Do Study Act (PDSA) cycles were used to test the interventions piloted on these wards. Once the processes had been found to be reliable on the pilot wards spread to other wards across the organisation was planned.

Results: All pilot wards showed success in the process measures. The renal ward was particularly successful in reducing cases of C. difficile disease. A 50% reduction has been seen in the number of cases of C. difficile experienced by patients on the ward between July 2008 and August 2009 compared with the previous year. A more modest reduction has been seen on the other pilot wards. With engagement of other wards across the organisation a significant reduction in C. difficile disease has been seen. 916 new cases of C. difficile were seen in 2008; 556 cases have been diagnosed to end October 2009.

Conclusions: The utilisation of 1000 Lives patient safety methodology to reduce C. difficile disease within Cardiff and Vale University Health Board has been successful in engaging staff at ward level in Infection Control work. The linking of interventions with process and outcome measures has encouraged ownership of the problem by ward level staff. A significant reduction in C. difficile disease has been seen.