Background: Since 2015 the rate of healthcare facility-onset Clostridium difficile infections (HO CDI) at Faxton-St Luke’s Healthcare (FSLH) has remained higher than both New York state and federal benchmarks, despite the use of traditional prevention efforts. Methods: We used the define-measure-analyze-improve-control (DMAIC) process improvement model to better understand the reasons that our rates remained high and to develop a comprehensive reduction strategy.

• • Define: High HO CDI rates. NHSN SIR consistently above 1.0

• • Measure

• • Diagnostic stewardship. Are patients being tested appropriately?

• • Antibiotic stewardship: Do prescribing practices follow best-practice recommendations?

• • Environmental cleanliness: Are staff following standard and transmission based precautions? How effective are current cleaning practices? What is being done to limit contamination of the environment of care?

• • Perform a gap analysis of CDI prevention strategies at FSLH vs current best practice recommendations, emerging strategies in scientific literature and successful approaches at other health-care facilities.

• • Analyze

• • Staff do not have a clear understanding of symptoms and risk factors of CDI and often initiate testing inappropriately.

• • Overuse of broad spectrum antimicrobial agents. No antibiotic time outs. Limited Pharmacy staff available for auditing and feedback regarding prescribing practices.

• • UV disinfection system under-utilized. Shared patient care equipment not cleaned between uses. Delay in implementation of contact precautions. Lack of opportunities for patient hand hygiene.

• • Improve

• • Algorithms for screening and testing built into Electronic Medical Record Orders for testing coupled with orders for contact precautions

• • Align antimicrobial prescribing with best practice

• • Audit and reward compliance with UV light utilization, environmental cleaning Reduce shared patient care equipment, replace with disposable items

• • Provide products for patient hand hygiene

• • Implement marketing campaign to tie elements together

• • Control

• • Audit compliance with testing and isolation policies

• • Laboratory rejection of formed stools

• • Audit cleaning processes with adenosine triphosphate (ATP) monitor

• • Track ultraviolet light usage

Funding: None

Disclosures: None