January 15, 2020
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Targeted strategy demonstrates efficacy for reducing C. difficile infection rates

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The Targeted Assessment for Prevention Strategy, a quality improvement framework for infection prevention, significantly reduced the number of Clostridioides difficile events at the system level and in an individual hospital, according to a study published in Infection Control & Hospital Epidemiology.

“The CMS Quality Innovation Networks–Quality Improvement Organizations [QIN-QIOs] and the CDC collaborated to pilot test the Targeted Assessment for Prevention [TAP] Strategy in 2015 and 2016,” the authors wrote. “During this piloting process, the CDC developed tools and provided direct technical assistance to the participating QIN-QIOs as they implemented the TAP Strategy among their participating hospitals. The Health Services Advisory Group, the QIN-QIO for Arizona, California, Florida, Ohio and the U.S. Virgin Islands, worked with a three-hospital system in Florida to prevent hospital-onset C. difficile infection.”

The TAP Strategy uses three primary elements: targeting health care facilities and/or specific units with an excess rate of health care-associated infections (HAIs); evaluating these organizations to identify gaps in infection prevention strategies and practices with standardized assessment tools; and preventing infections by putting in place interventions that target these gaps. Katelyn A. White, MPH, of the Division of Healthcare Quality Promotion, and colleagues examined the processes used to implement the TAP Strategy in the three Florida hospitals and evaluated the efficacy of the strategy in terms of reducing C. difficile infections.

Hospital A was selected through C. difficile infection surveillance data that demonstrated an excess burden of infections above the national goal. Hospitals B and C were selected “as part of systemwide deployment,” according to the study results. TAP facility evaluations were conducted to identify gaps in infection control and develop strategies for C. difficile infection prevention.

White and colleagues performed a retrospective analysis with negative-binomial interrupted time series regression to examine the overall impact of prevention efforts. The analysis included hospital-onset, laboratory-identified C. difficile event data for 18 months before and after the TAP facility assessments.

Hospital A had 528 beds; hospital B had 311 beds and hospital C had 106 beds. All hospitals were affiliated with a graduate school; all hospitals also had ICUs and at least one infection control practitioner. None of the hospitals performed transplants (heart, kidney or bone marrow) and none of them had burn units.

Systemwide pooled mean hospital-onset C. difficile infection rates declined by 53.8% (95% CI, 43.5% to 62.2%) from 1.14 per 1,000 patient days in the preintervention period to 0.53 in the postintervention period. The pooled mean incidence of community-onset C. difficile at the system level decreased from 0.92% in the preintervention period to 0.40% in the postintervention period. Monthly rates of C. difficile infection were typically greater before the start of the intervention and seemed to decline over time during the intervention period, especially at the system level and at hospital A, the facility that was originally found to have the greatest cumulative attributable difference of the three health care systems studied.

White and colleagues acknowledge several limitations of their study, including the fact that the TAP Strategy was created “as a quality improvement framework and was implemented among these hospitals with the goal of infection prevention, not with the purpose of studying the impact of this strategy.” However, the results of this pilot project did demonstrate that “a reduction in [C. difficile] events is possible with implementation of the TAP Strategy and can serve as a model of coordinated and targeted prevention efforts.” The authors also note that the TAP Strategy is “modifiable and scalable.”

“Facilities and health care systems should consider implementing the TAP Strategy, in addition to their ongoing prevention efforts, to improve processes and outcomes as they work toward the national goal of HAI reduction and elimination,” White and colleagues concluded. – by Erin T. Welsh

Disclosures: The authors report no relevant financial disclosures.