Date of Award

5-12-2017

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Jamie El Harit

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-oftime 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 pretest 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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