MountainView Hospital

Process Improvements and Culture Change Drive C. diff Decrease

Harsha Dave, RN, BSN, BSMT(ASCP), CIC
Jan Olivas, MBA, RN, CPHRM, CPPS
Lisa Schaffer, RN, CIC
MountainView Hospital
Las Vegas, Nevada

The Infection Prevention and Quality departments at MountainView Hospital combined evidence-based process improvements with an emphasis on front-line collaboration to significantly enhance safety for their patients.

In early 2015, the team “de-engineered” the healthcare-associated infections (HAIs) their facility was reporting to identify specific improvement opportunities. Leveraging their varied medical technology, quality, and nursing backgrounds, Harsha Dave, Jan Olivas, and Lisa Schaffer then created processes to reduce HAIs across the board, with an emphasis on Clostridium difficile (C. diff).

C. diff was even lower hanging fruit than some of the other HAIs because of the inappropriate testing we identified,” Olivas said.

Using evidence-based guidelines, the team developed a C. diff testing algorithm designed to prevent unnecessary and duplicative C. diff testing. The algorithm was disseminated to all healthcare workers in the facility and medical staff leadership support for the project and appropriate testing was clear.

Other process improvements included ongoing education about C. diff (including appropriate testing) at all levels, antibiotic de-escalation and emphasis on proper environmental cleaning.

Dave, Olivas, and Schaffer greatly enhanced adoption of these improvements through a relentless focus on collaboration and communication.

“Infection prevention doesn’t live behind a desk. It lives on the units and at the bedside,” Dave said. “We are on the units educating, communicating, and breaking down barriers.” The team also empowered “mini infection preventionists” on every unit.

The appropriateness of C. diff testing at MountainView has greatly improved and the facility’s C. diff rate dropped from 1.78 standardized infection ratio (SIR) in 2015 to 0.56 in mid-2016.

“We found those passionate people who were truly interested to be patient advocates and engaged them to help us change the culture and the outcome,” Schaffer said.