Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Health Services Advisory Group, Tampa, Florida.
Infect Control Hosp Epidemiol. 2020 Mar;41(3):295-301. doi: 10.1017/ice.2019.358. Epub 2020 Jan 13.
Prevention of Clostridioides difficile infection (CDI) is a national priority and may be facilitated by deployment of the Targeted Assessment for Prevention (TAP) Strategy, a quality improvement framework providing a focused approach to infection prevention. This article describes the process and outcomes of TAP Strategy implementation for CDI prevention in a healthcare system.
Hospital A was identified based on CDI surveillance data indicating an excess burden of infections above the national goal; hospitals B and C participated as part of systemwide deployment. TAP facility assessments were administered to staff to identify infection control gaps and inform CDI prevention interventions. Retrospective analysis was performed using negative-binomial, interrupted time series (ITS) regression to assess overall effect of targeted CDI prevention efforts. Analysis included hospital-onset, laboratory-identified C. difficile event data for 18 months before and after implementation of the TAP facility assessments.
The systemwide monthly CDI rate significantly decreased at the intervention (β2, -44%; P = .017), and the postintervention CDI rate trend showed a sustained decrease (β1 + β3; -12% per month; P = .008). At an individual hospital level, the CDI rate trend significantly decreased in the postintervention period at hospital A only (β1 + β3, -26% per month; P = .003).
This project demonstrates TAP Strategy implementation in a healthcare system, yielding significant decrease in the laboratory-identified C. difficile rate trend in the postintervention period at the system level and in hospital A. This project highlights the potential benefit of directing prevention efforts to facilities with the highest burden of excess infections to more efficiently reduce CDI rates.
预防艰难梭菌感染（CDI）是国家重点关注的问题，而 TAP 策略（一种质量改进框架，提供了一种针对感染预防的集中方法）的实施可能会对此有所帮助。本文描述了在医疗保健系统中实施 TAP 策略以预防 CDI 的过程和结果。
根据 CDI 监测数据，A 医院的感染负担高于全国目标，因此将其确定为研究对象；B 医院和 C 医院作为系统部署的一部分参与了研究。对员工进行 TAP 设施评估，以确定感染控制差距并为 CDI 预防干预措施提供信息。采用负二项式、中断时间序列（ITS）回归进行回顾性分析，以评估针对 CDI 预防工作的总体效果。分析包括 TAP 设施评估实施前和实施后 18 个月的医院获得性、实验室鉴定的艰难梭菌事件数据。
在干预期间，系统范围内的每月 CDI 发生率显著降低（β2，-44%；P =.017），并且干预后 CDI 发生率趋势呈持续下降（β1 + β3；每月下降 12%；P =.008）。在个别医院层面，仅在 A 医院，干预后 CDI 发生率趋势显著降低（β1 + β3，每月下降 26%；P =.003）。
本项目展示了 TAP 策略在医疗保健系统中的实施，在系统层面和 A 医院的干预后期间，实验室鉴定的艰难梭菌率趋势显著下降。本项目强调了将预防工作重点放在感染负担过重的设施上，以更有效地降低 CDI 发生率的潜力。
