The Effect of Bundled Interventions on Prevention of Hospital Acquired Clostridium Difficile Infection

117 Pages·2017·1.32 MB·English

Valparaiso University
ValpoScholar
Evidence-Based Practice Project Reports College of Nursing and Health Professions
5-12-2017
The Effect of Bundled Interventions on Prevention
of Hospital Acquired Clostridium Difficile
Infection
Kaitlin Kendys
Valparaiso University, [email protected]
Follow this and additional works at:http://scholar.valpo.edu/ebpr
Part of theBacterial Infections and Mycoses Commons,Health and Medical Administration
Commons,Nursing Commons, and thePublic Health Commons
Recommended Citation
Kendys, Kaitlin, "The Effect of Bundled Interventions on Prevention of Hospital Acquired Clostridium Difficile Infection" (2017).
Evidence-Based Practice Project Reports. 99.
http://scholar.valpo.edu/ebpr/99
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DEDICATION
I would like to dedicate this EBP project to my family, without whom I would not have
completed this degree. My mother who watched over me from heaven and my husband helped
carry me through this process. I share this with my family and friends who made it all possible.

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ACKNOWLEDGMENTS
I would like to thank many for their support and direction with this EBP project. First, I
would like to thank Professor Jamie El Harit, DNP, RN, FNP-BC, CSSBB for her support and
knowledge that guided me through this process. Additionally, I would like to thank Chris
Shakula, MSN, RN for her support with the project implementation. I would like to thank Holly
Dinell, BSN, RN and Lynn Idalski, BSN, RN for their assistance with this project. Finally, I would
also like to acknowledge the staff and management team at X Hospital for welcoming and
accepting this project.
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TABLE OF CONTENTS
Chapter Page
DEDICATION……………………………………………………………………………iii
ACKNOWLEDGMENTS……………………………………………………..………..iv
TABLE OF CONTENTS ………………………………………………………….……vi
LIST OF TABLES……………………………………………………………………...xx
LIST OF FIGURES …………………………………………………………..….……xx
ABSTRACT……………………………………………………………….………..…..xx
CHAPTERS
CHAPTER 1 – Introduction …………………………………………………….1
CHAPTER 2 – Theoretical Framework and Review of Literature …..……15
CHAPTER 3 – Implementation of Practice Change ……………………….46
CHAPTER 4 – Findings……………………………………………………….58
CHAPTER 5 – Discussion………………...…………………………………..73
REFERENCES………………………………………..…………………..……………85
AUTOBIOGRAPHICAL STATEMENT……………..…………..…………………….87
ACRONYM LIST……………………………………..…………………..……………..88
APPENDICES
APPENDIX A – Summary of Appraised Literature…………………...…….89
APPENDIX B – CDC Environmental Checklist for Monitoring Terminal
Cleaning, Contact Precautions Monitoring Tool,
and WHO Hand Hygiene Observation Form………..95

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APPENDIX C – Put In-service Session Flyers, Intervention Outline,
and CDC Deadly Diarrhea Handout………………..101
APPENDIX D – Participant Demographic Data..………………………….107
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LIST OF TABLES
Table Page
Table 2.1 Database Search Results………………………………………………...44
Table 2.2 Levels of Evidence……..………………………………………………….45
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LIST OF FIGURES
Figure Page
Figure 4.1 Pre-intervention Hand Hygiene..…………………………………...…..64
Figure 4.2 Post-intervention Hand Hygiene…………………………………….…65
Figure 4.3 Hand Hygiene Compliance……………………………………………..66
Figure 4.4 Pre-intervention Contact Isolation Precautions……………………....67
Figure 4.5 Post-intervention Contact Isolation Precautions………………….….68
Figure 4.6 Contact Isolation Precaution Compliance……...………………….….69
Figure 4.7 CDI Incidence Pre-intervention………………….………………….….70
Figure 4.8 CDI Incidence Post-intervention………………….………………….…71
Figure 4.9 CDI Incidence Data…………….………………….………………….…72

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ABSTRACT
Clostridium difficile infection (CDI) rates have steadily increased in hospitalized patients due to the
change in epidemiology. Approximately 13 of every 1,000 inpatients are either infected or colonized with
C. difficile (CDC, 2013). CDI rates continue to rise due to the hyper-virulent strain of C. difficile and length
of therapy needed to treat CDI. The average cost for a single inpatient CDI is more than $35,000, and the
estimated annual cost burden for the healthcare system exceeds $3 billion (Walsh, 2012). The purpose of
this evidence-based project (EBP) was to reduce hospital-acquired CDI rates over a 3-month period-of-
time from November 2016 to February 2017 through the implementation of a bundle of care including: (a)
proper hand hygiene practices, (b) adequate and appropriate surface cleaning practices, (c) compliance
to contact isolation procedures, and (d) strengthening of an existing antibiotic stewardship committee.
The Health Promotion Model and the Stetler Model of EBP guided this system change. A longitudinal pre-
test post-test design using all CDI inpatients from a general medical unit in Northwest Indiana was
implemented. Descriptive statistics were used to document specific interventions used during the EBP
project and compared with post-test chart audits from the same timeframe of the previous year. Collected
data included CDI incidence, compliance to hand hygiene, contact isolation procedures, and
environmental surface cleaning protocols, as well as de-escalation and timely discontinuation of
antibiotics, and appropriate selection of antimicrobial therapy. An independent samples t-test indicated
that there was no significant difference between the CDI incidence pre-intervention (M =.30, SD =.470)
and post-intervention (M =.24, SD =.431); t (19) = .000, p = .059. Despite the lack of significance in CDI
rates, a repeated-measures ANOVA was performed to examine the relation between pre- and post-test
hand hygiene compliance and contact isolation precaution compliance which did demonstrate significant
effects with both hand hygiene compliance and on compliance to contact isolation precautions, Wilks’
Lambda= .558, F (3, 37) = 9, p = .000 and Wilks’ Lambda= .375, F (3, 37) = 20, p = .000. A 96.8%
surface cleaning compliance with 10% sodium hypochlorite solution was noted post-intervention. The
educational data provided in this EBP project has been adopted by the facility and will be used for new
hire education and annual competencies. An electronic best practice advisory will be implemented in the
electronic health record to alert healthcare providers of alternative antimicrobial therapies.
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