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

Published online by Cambridge University Press:  13 January 2020

Katelyn A. White Open the ORCID record for Katelyn A. White [Opens in a new window] ,
Minn M. Soe ,
Amy Osborn ,
Christie Walling ,
Lucy V. Fike ,
Carolyn V. Gould ,
David T. Kuhar ,
Jonathan R. Edwards  and
Ronda L. Cochran
Katelyn A. White*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Minn M. Soe
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Amy Osborn
Affiliation:
Health Services Advisory Group, Tampa, Florida
Christie Walling
Affiliation:
St. Vincent’s HealthCare, Ascension, Jacksonville, Florida
Lucy V. Fike
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Carolyn V. Gould
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
David T. Kuhar
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Jonathan R. Edwards
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Ronda L. Cochran
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Author for correspondence: Katelyn A. White, E-mail: wwg6@cdc.gov
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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.

Keywords

Targeted Assessment for Prevention StrategyTAPhealthcare-associated infectionshospital infection prevention and controlquality improvementcumulative attributable differenceClostridioides difficile InfectionNational Healthcare Safety Networksurveillance data for actionTAP Reportnegative-binomial interrupted time series regressionstandardized infection ratioinfection prevention interventionsHAIreduction
Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 3 , March 2020 , pp. 295 - 301
Creative Commons
Creative Common License - CCCreative Common License - BY
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

a

Contributing members of the St Vincent’s CDI Task Force who led the prevention efforts described and continue to work on the CDI reduction initiative include Kenneth Rothfield MD, Frances Valencia-Shelton PhD, Florian Daragjati PharmD, Amy Svensson RN, Dorothy Salvatore RN, Bonnie Viergutz RN, Melodee Miller RN, Ronald Owen RN, Irene Pappalardo RN, Casey Higginbotham RN, Larita Knight RN, Laurie Mai RN, June Oliverson RN, and Christie Walling RN.

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