Preventing Clostridioides difficile Infection (CDI)

CDI is a bacterial infection often resulting in considerable morbidity and mortality, especially in immunocompromised patients.¹ CDI is highly contagious, with symptoms including diarrhea, fever, stomach pain, loss of appetite, and nausea.² Risk factors include being age 65 and older, recently hospitalized or in a nursing home; having a weakened immune system; and having a previous CDI or exposure.²

There are no vaccines and there is increasing incidence of new strains appearing.³ Clostridioides difficile (C. difficile) spores are highly resistant and persist in the environment, increasing the likelihood of spread. Antibiotics are the primary treatment, yet they cause an imbalance in gut bacteria, which is a major factor allowing C. difficile to colonize in the gut and cause diarrhea and colitis in the first place.⁴ Emerging C. difficile antibiotic resistance is an additional risk.⁴

Prevention Is Key

The following are prevention strategies: “isolate and initiate contact precautions for suspected or confirmed CDI, confirm CDI in patients, perform environmental cleaning to prevent CDI, develop infrastructure to support CDI prevention, and engage the facility antibiotic stewardship program.”⁵

Contact your HSAG Quality Advisor for a CDI Environmental Services (EVS) Checklist, CDI Collection Algorithm, and/or CDI Tracer and Action Plan.

Data show that CDI rates have improved since the baseline period of 2019 (lower rates are better).

Visit the HSAG HQIC Quality Improvement and Innovation Portal (QIIP) to view your CDI data by selecting the “Measure” Category of HAI-MDRO and “Measure” of C. diff Infection Rate.

HAI = healthcare-associated infection

MDRO = multi-drug resistant organism

* Rates are per 1,000 admissions.

Source: National Healthcare Safety Network (NHSN) data. For additional details on measure specifications, please reference the HSAG HQIC Compendium of Measures. The baseline time period is 01/01/2019–12/31/2019 and current time period is 02/01/2023–01/31/2024

Health Equity Measure

The attestation period for the calendar year 2023 reporting period/fiscal year 2025 payment determination for the Health Equity Measure is April 1, 2024–May 15, 2024. Attestation will take place via the Hospital Quality Reporting (HQR) system. The five domains are (1) Equity as a Strategic Priority, (2) Data Collection, (3) Data Analysis, (4) Quality Improvement, and (5) Leadership Engagement. 

For further guidance, see the Centers for Medicare & Medicaid Services (CMS) Attestation Guide for the Hospital Commitment to Health Equity Measure, and HSAG HQIC Health Equity Tools and Resources (below).

Ensuring Medication for Opioid Use Disorder (MOUD) Treatment Through the Care Continuum

This webinar series—a collaboration of all Quality Improvement Organizations—provides strategies, interventions, and targeted solutions to ensure Medicare beneficiaries have access to MOUD treatment and facilitate the continuity of care.

Next: April 12, 2024 | 12 noon ET (9 a.m. PT).

Care Coordination Quickinar Series: Readmission Incentive and Penalty Programs

Discover ways to manage avoidable hospital readmissions by registering for these short, 30-minute webinars (quickinars)—offered monthly January through May 2024. Find details and recordings for past presentations on the webpage.

1st Tuesdays. Next: May 7, 2024 | 2–2:30 p.m. ET (11 a.m. PT)

Find on-demand quickinar recordings, slides, and podcasts from past HSAG HQIC learning series.

Quality and Safety Quickinar Series

References

Bainum TR. Controversies in the prevention and treatment of Clostridiodes difficile infection in adults: a narrative review. Microorganisms. 2023. https://doi.org/10.3390/microorganisms11020387

2 Centers for Disease Control and Prevention (CDC). What is C. diff? https://www.cdc.gov/cdiff/what-is.html

3 Lim SC, Knight DR, Riley TV. Clostridium difficile and One Health. Clinical Microbiology and Infection. 2020. https://www.sciencedirect.com/science/article/pii/S1198743X19305592

4 Heuler J, Fortier L, Sun X. Clostridioides difficile phage biology and application. FEMS Microbiology Reviews. 2021. https://academic.oup.com/femsre/article/45/5/fuab012/6134755

5 CDC. CDI Prevention Strategies. https://www.cdc.gov/cdiff/clinicians/cdi-prevention-strategies.html   

This material was prepared by Health Services Advisory Group (HSAG), a Hospital Quality Improvement Contractor (HQIC) under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication No XS-HQIC-XT-04032024-01