title: Effects of a predictive preventive model for prevention of Clostridium difficile infection in patients in intensive care units.
abstract: BACKGROUND
  Health care-acquired Clostridium difficile infection (HACDI) is associated with adverse outcomes at both the organization and patient level. Factors that increase risk for development of HACDI have been identified. Objectives of this study were to develop a predictive screening tool to identify patients at risk for HACDI and implement a bundle of mitigation interventions.
  
  
  METHODS
  A predictive screening tool was developed based on risk factors identified in the literature and validated by retrospective analysis of all HACDI cases occurring in critically ill patients during 2013. The tool was used to screen all patients admitted to an intensive care unit. Evidence-based interventions (bundle) were implemented for patients identified as being at high risk for HACDI. Effectiveness of the model was measured by reduction of HACDI rate during the intervention period compared with the preintervention period.
  
  
  RESULTS
  During the 12-month intervention period 217 high-risk patients were identified as infected with Clostridium difficile. Sixty-two of these met exclusion criteria, resulting in a study population of 157 patients. During the preintervention phase, 10 cases of HACDI occurred (overall incidence rate, 14.7). During the 12-month study period, 2 cases of HACDI were identified (incidence rate, 3.12). The reduction was statistically significant.
  
  
  CONCLUSIONS
  A strategy for identifying patients at increased risk and implementation of multidisciplinary risk-mitigation strategies is effective in reducing incidence of HACDI.
authors.affiliation: Vascular-Thoracic Intensive Care Unit, Florida Hospital, Orlando, FL. Electronic address: alba.gonzalezcruz@flhosp.org.
authors.forename: Alba
authors.initials: A
authors.lastname: Cruz-Betancourt
authors.affiliation: Infection Prevention Department, Florida Hospital, Orlando, FL.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Cooper
authors.affiliation: Infection Prevention Department, Florida Hospital, Orlando, FL.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Sposato
authors.affiliation: Infection Prevention Department, Florida Hospital, Orlando, FL.
authors.forename: Hermanda
authors.initials: H
authors.lastname: Milton
authors.affiliation: Department of Pharmacy, Florida Hospital, Orlando, FL.
authors.forename: Patricia
authors.initials: P
authors.lastname: Louzon
authors.affiliation: Office of Research Administration, Florida Hospital, Orlando, FL.
authors.forename: Julie
authors.initials: J
authors.lastname: Pepe
authors.affiliation: Department of Pharmacy, Florida Hospital, Orlando, FL.
authors.forename: Ramy
authors.initials: R
authors.lastname: Girgis
authors.affiliation: Department of Pharmacy, Florida Hospital, Orlando, FL.
authors.forename: Seema V
authors.initials: SV
authors.lastname: Patel
authors.affiliation: Department of Pharmacy, Florida Hospital, Orlando, FL.
authors.forename: Dina
authors.initials: D
authors.lastname: Ibrahim
authors.affiliation: Vascular-Thoracic Intensive Care Unit, Florida Hospital, Orlando, FL.
authors.forename: Sandra
authors.initials: S
authors.lastname: Van Horn
authors.affiliation: Infection Prevention Department, Florida Hospital, Orlando, FL.
authors.forename: Vincent
authors.initials: V
authors.lastname: Hsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000175:diagnosis*; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000175:diagnosis* / Q000517:prevention & control; D003428:Cross Infection / Q000517:prevention & control; D003661:Decision Support Techniques; D004761:Enterocolitis, Pseudomembranous / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies
keywords: CDI; HA-CDI; multidisciplinary; screening tool