Proposed checklist of hospital interventions to decrease the incidence of healthcare-associated Clostridium difficile infection

Infect Control Hosp Epidemiol. 2009 Nov;30(11):1062-9. doi: 10.1086/644757.


Background: The incidence and severity of Clostridium difficile infection (CDI) are increasing, and previously described interventions for controlling the spread of CDI are not easily generalized to multiple healthcare institutions.

Objective: We tested prevention and treatment bundles to decrease the incidence of CDI and the mortality associated with CDI at our hospital.

Design: Observational before-after study of adult patients admitted to a tertiary care, university-affiliated hospital during the period from January 2004 through December 2008.

Methods: In January 2006, we launched an educational campaign and introduced a prevention bundle-a series of specific processes aimed at preventing the transmission of C. difficile among hospitalized patients, including enhanced isolation practices, laboratory notification procedures, and steps coordinating infection control and environmental services activities. In April 2006, we implemented a treatment bundle-a set of hospital-wide treatment practices aimed at minimizing the risk of serious CDI complications. We tracked quarterly incidence rates and case-fatality rates for healthcare-associated CDI cases at our hospital. Our main outcome was the healthcare-associated CDI incidence rate, measured as the number of healthcare-associated cases of CDI per 1,000 patient-days.

Results: We followed patients for a total of 1,047,849 patient-days. The healthcare-associated CDI incidence rates fell from an average of 1.10 cases per 1,000 patient-days before intervention to 0.66 cases per 1,000 patient-days after intervention. This statistically significant decrease amounts to a 40% reduction in incidence after the intervention.

Conclusions: Our intervention was successful in reducing the incidence of CDI at our hospital. On the basis of our experience, we propose the use of a checklist of hospital interventions to decrease the incidence of healthcare-associated CDI.

MeSH terms

  • Adult
  • Boston
  • Checklist*
  • Clostridioides difficile / drug effects*
  • Clostridium Infections* / drug therapy
  • Clostridium Infections* / epidemiology
  • Clostridium Infections* / mortality
  • Clostridium Infections* / prevention & control
  • Cross Infection* / drug therapy
  • Cross Infection* / epidemiology
  • Cross Infection* / mortality
  • Cross Infection* / prevention & control
  • Enterocolitis, Pseudomembranous* / drug therapy
  • Enterocolitis, Pseudomembranous* / epidemiology
  • Enterocolitis, Pseudomembranous* / mortality
  • Enterocolitis, Pseudomembranous* / prevention & control
  • Female
  • Hand Disinfection / methods
  • Health Personnel / education
  • Hospitals, University
  • Housekeeping, Hospital / methods
  • Humans
  • Incidence
  • Infection Control / methods*
  • Male