Clostridioides difficile infection (CDI) Guide to Patient Safety (GPS)
About the GPS
The Clostridioides difficile infection (CDI) Guide to Patient Safety (GPS) is a brief troubleshooting tool to aid infection prevention teams in reducing CDI in their hospital or unit. Modeled after the validated catheter-associated urinary tract infection (CAUTI) GPS developed by researchers at Veterans Affairs Ann Arbor Healthcare System and University of Michigan, the CDI GPS is designed to help teams re-examine their CDI data and prevention activities, and direct them toward specific strategies and resources to overcome barriers and challenges.
The CDI GPS is a brief self-administered assessment of yes/no questions. Multidisciplinary CDI prevention teams should either, thoughtfully as a group, or independently followed by group review, answer the 11 questions that comprise the assessment. When done this way, the guide can stimulate discussion and uncover barriers that may be impeding CDI reduction progress. For more information on Tier 1 and 2 CDI prevention strategies, review the CDI Prevention resources on the CDC/STRIVE Infection Control Training website.
Instructions for Use
To accurately assess the team’s CDI prevention efforts, it is recommended that:
The CDI GPS is a brief self-administered assessment of yes/no questions. Multidisciplinary CDI prevention teams should either, thoughtfully as a group, or independently followed by group review, answer the 11 questions that comprise the assessment. When done this way, the guide can stimulate discussion and uncover barriers that may be impeding CDI reduction progress. For more information on Tier 1 and 2 CDI prevention strategies, review the CDI Prevention resources on the CDC/STRIVE Infection Control Training website.
Instructions for Use
To accurately assess the team’s CDI prevention efforts, it is recommended that:
- The team working on CDI prevention at the hospital or unit-level completes the CDI GPS assessment. This can be done independently or as a group.
- The responses are reviewed as a team as a means to uncover strengths and barriers to reducing CDI.
- For questions that were answered with a “No,” the team should click on the link below the question or reference the indicated section to review approaches, advice, tools and resources to better implement the indicated CDI prevention strategy.
- If you answered “Yes” to all the questions and your CDI rates are not where you want them to be, consider viewing the Enhanced Interventions to Prevent CDI module (CDI 202) on the CDC/STRIVE Infection Control Training website.
This tool was developed as part of the STRIVE collaboration. Funding was provided by the Centers for Disease Control and Prevention, STRIVE Program (contract number 200-2015-88275), and project support was provided by the Health Research & Educational Trust, Department of Veterans Affairs, and the University of Michigan.
A full, PDF copy of all the information available in this Guide is available (also linked at the bottom of this page, below the questions section).
Question 1: Do you currently have a well functioning team (or work group) focusing on CDI prevention?
Yes
You have a well functioning team focusing on CDI prevention. This is very helpful since this team is vital in developing a CDI prevention program and assisting with program implementation. Be sure to use your team to its full capacity.
No
You indicated that either you don’t have a team or work group or the one you have does not function well. A key aspect of implementing a CDI prevention initiative is to identify an implementation team at your site. This team plays a critical role in developing the initiative and assisting with implementation. Key responsibilities of this team are education, data collection and evaluation. Individuals can fill more than one role and some may be short-term and others longer-term.
Question 2: Do you have a team leader with dedicated time to coordinate your CDI prevention activities?
Yes
You indicated that you have a team leader who has dedicated time for the initiative. This is important to keep the project moving forward in a timely manner and to recognize and address barriers and challenges as they come up. As s/he becomes involved with other projects make sure that time on this project remains protected.
No
You indicated that either you do not have a team leader or that the one you have does not have appropriate time for the initiative. The team leader is responsible for coordinating CDI prevention efforts and integrating CDI prevention practices into daily workflow and collaborating with the various initiative champions. In other words, the details of the CDI prevention initiative fall to the team leader. It is his or her responsibility to keep the infection prevention efforts moving forward and coordinate the moving pieces. It is unlikely that the CDI prevention initiative is the only responsibility of the team leader, and because of this, there may not be enough time devoted to the prevention efforts. Creating that dedicated time is imperative to a successful initiative.
Question 3: Do you have an effective physician champion for your CDI prevention activities?
Yes
You indicated that you have an effective physician champion for your initiative. Despite the initiative relying heavily on nursing efforts, physician awareness, engagement, and support is key for the success of the project. Your physician champion should continue to communicate with staff so that if an issue does arise s/he is aware of it as soon as possible.
No
You indicated that either you do not have a physician champion or that the one you have is not effective. The physician champion is responsible for engaging physicians in CDI prevention efforts and coordinating CDI prevention efforts that require physician support. A successful CDI prevention initiative requires collaboration and cooperation with physicians. A physician champion is needed to bring the initiative to the other physicians, to help engage them, to be a part of problem solving when there is resistance or another challenge from this group of providers, and to gain physician cooperation.
Question 4: Is senior leadership supportive of CDI prevention activities?
Yes
You indicated that you have supportive senior leadership for your initiative. It is important to occasionally reassess this as new initiatives and priorities are constantly being introduced.
No
You indicated that you do not have the support of senior leadership. Given the many competing priorities of hospitals, having the support of leadership is key to making immediate and lasting progress with your CDI prevention initiative. Having a member of the hospital executive leadership team oversee the initiative signals the importance of the initiative to the hospital staff.
Question 5: Do you routinely collect CDI-related data (e.g., incidence, prevalence, compliance with prevention practices) in the unit(s) or populations in which you are intervening?
Yes
You currently collect CDI-related data. It is important to collect these measures as the project continues and once you have entered in to the sustainability phase. Discuss with the CDI prevention team if there are other measures that would be helpful to collect.
No
You indicated that you do not currently collect CDI-related data. Collecting, measuring, analyzing and reporting information on your CDI prevention activities are critical to ensure continued success. Outcome data, such as total CDI burden, enable you to monitor the success of your CDI prevention initiatives and allow teams to compare how they are doing in their prevention efforts to other units and hospitals. Additionally, as health care moves from fee-for-service models of care to value-based compensation, healthcare-associated infection (HAI) rates, including CDI rates, are important metrics for determining care reimbursement. Process measures, such as hand hygiene compliance rates and the use of high-risk antibiotics, like fluoroquinolones, ensure that process interventions are being effectively implemented and point to areas that require continued enhancement or intervention. Lastly, sharing and highlighting data are crucial strategies for engaging physicians, frontline staff and senior leaders in infection prevention efforts.
Question 6: Do you routinely feed back CDI-related data to frontline staff and physicians? (e.g., incidence, prevalence, compliance with prevention practices)
Yes
You currently feed CDI-related data back to frontline staff. No matter what stage of the initiative you are in, it is important to continue to provide this information. It is helpful to occasionally change how you communicate this data to the staff so that they continue to be engaged and motivated by it.
No
You indicated that you do not routinely feed back CDI-related data to frontline staff, which includes physicians. While collecting CDI-related data is key to measuring success, it is imperative that the staff, especially those on the frontline, are aware of it. Data transparency can help motivate and engage staff at all stages of the initiative, as well as encourage them to continue the changes, promoting sustainability. Simply put, feedback improves motivation and learning. Feed back hospital intervention data, as well as data from comparable hospitals and national aggregates. Simple run charts or a MRSA scorecard are great ways to quickly display and easily communicate data to both frontline staff and senior leaders.
Question 7: Is staff empowered to speak up and remind colleagues about proper hand hygiene and personal protective equipment use?
Yes
You currently empower your staff to speak up if hand hygiene is not performed effectively, or personal protective equipment is not used properly. Effective use of these measures is critical to preventing the transmission of C. difficile, and thus CDI. Stay vigilant and continue to encourage everyone to speak up!
No
You indicated that staff are not empowered to speak up to remind colleagues to perform proper hand hygiene and use personal protective equipment (PPE). A key aspect of preventing CDI is preventing C. difficile transmission. Staff should be encouraged and empowered to remind colleagues about strict glove use, wearing proper PPE and performing hand hygiene. Consider using a facility-wide common reminder phrase to get everyone on the same page and keep reminders from feeling punitive; it’s about patient safety, not punishment.
Question 8: Do you conduct audits and provide feedback on the effectiveness of environmental cleaning?
Yes
You currently audit and provide feedback on the effectiveness of environmental cleaning. Hospitals and units need to ensure that environmental cleaning and disinfection are effectively decontaminating patient rooms and equipment, and these are effective ways to accomplish that.
No
You indicated that you do not conduct audits or provide feedback to staff on the effectiveness of environmental cleaning. Transmission of C. difficile is similar to other pathogens spread by contact; bacteria or bacterial spores can contaminate the patient or their environment and then be passed on to other patients via health care personnel or shared equipment, or to the next occupant of the patient room. A key aspect of preventing CDI is preventing C. difficile transmission. Hospitals and units need to ensure that environmental cleaning and disinfection are effectively decontaminating patient rooms and equipment.
Question 9: Do you have an antibiotic stewardship team that includes at least one physician and one pharmacist?
Yes
You currently have an antibiotic stewardship team with key personnel to support and champion appropriate antibiotic use. Preventing the inappropriate use of antibiotics is a key factor in preventing CDI.
No
You indicated that you do not have at least one physician and/or one pharmacist engaged on your hospital’s antibiotic stewardship team. Inappropriate and avoidable exposure to antibiotics is the single most important risk factor for developing CDI. A successful CDI prevention initiative requires collaboration and cooperation with physicians and pharmacists. Physician and pharmacist champions can help bring the initiative to the other physicians and pharmacists, aid with engagement and be a part of problem solving when there is resistance or another challenge from providers.
Question 10: Does your laboratory reject formed stools if submitted for CDI testing?
Yes
Your laboratory rejects formed stools submitted for CDI testing. Having clear boundaries for lab specimen acceptance encourages appropriate use of testing, and keeps laboratory test results within the clinical context.
No
You indicated that your laboratory does not reject formed stools submitted for CDI testing. It is important to remember that C. difficile infection is a clinical diagnosis; lab tests help support a clinical suspicion, but they should not be taken out of the clinical context. In order to limit inappropriate testing, clinical laboratories can set a threshold on the type of stool that is acceptable for C. difficile testing.
Question 11: Are clinicians educated as to when to order CDI testing?
Yes
Your clinicians know when to order CDI testing, allowing them reduce the number of false-positive test results they could get from the lab. Maintain your efforts to stay abreast of the latest recommendations regarding CDI testing.
No
You indicated that clinicians are not educated as to when it is appropriate to order CDI testing. CDI is a clinical diagnosis; lab tests help support a clinical suspicion, but they should not be taken out of the clinical context. It is important that clinicians are educated and informed of high C. difficile colonization rates to illustrate that indiscriminate testing will lead to false-positive results.