Table 2

Preintervention strengths and opportunities and selected intervention approaches for SPARC intervention hospitals*

DomainStrengths (n=12, %)Opportunities (n=12, %)Selected interventions (n=11, %)
Infection prevention
  • Isolation and contact procedures for possible and positive Clostridioides difficile cases (9, 75%).

  • Contact precaution communication between departments (7, 58%).

  • Well-staffed infection prevention department (7, 58%).

  • Compliance with hand hygiene procedures (5, 42%).

  • Compliance with PPE procedures (3, 25%).

  • Visitor compliance with PPE and hand hygiene (1, 8%).

  • Improve contact precaution communication (5, 42%).

  • Strengthen contact precaution compliance monitoring and education (4, 33%).

  • Improve compliance with hand hygiene guidelines (4, 33%).

  • Improve compliance with PPE guidelines (3, 25%).

  • Understaffed infection control departments (2, 17%).

  • Improve visitor compliance with PPE and hand hygiene (1, 8%).

  • PPE compliance monitoring and human factor interventions to improve utilisation (6, 55%).

  • Hand hygiene compliance monitoring and human factor interventions (3, 27%).

  • Improve signage and communication of C. difficile precautions (3, 27%).

  • Post and share C. difficile infection data with units and leadership (2, 18%).

Environmental cleaning
  • Environmental cleaning leadership and collaboration with hospital departments and units (11, 92%).

  • Environmental cleaning monitoring programme (8, 67%).

  • Environmental cleaning materials easily accessible, simple to use and use effective solutions (7, 58%).

  • Use of ultraviolet light after manual cleaning of C. difficile rooms (6, 50%).

  • Cleaning and disinfectant procedures lack standardisation or completion (10, 83%).

  • Improve cleaning materials’ accessibility, simplicity of use and efficacy (7, 58%).

  • Improve Environmental cleanliness monitoring and C. difficile data reporting to environmental cleaning staff (5, 42%).

  • Involve environmental cleaning leadership and staff in root cause analysis processes (4, 33%).

  • Issues with unengaged staff and issues communicating with patients (4, 33%).

  • Education/training on cleaning and disinfection protocols with environmental cleaning and other frontline staff (5, 46%).

  • Implementation of environmental cleaning monitoring programme using fluorescent gel (4, 36%).

  • Updated cleaning guidelines and protocols (3, 27%).

  • Other tracking and reporting activities (1, 9%).

Antibiotic stewardship
  • Infectious disease-trained pharmacist and/or dedicated Antimicrobial Stewardship Program staff with experience and knowledge to review antibiotic use (11, 92%).

  • High compliance with antibiotic restrictions, hard stops and guidance (9, 75%).

  • Antibiotic compliance data and reports accessible and shared with unit and providers (7, 58%).

  • Executive leadership recognises and collaborates with ASP (7, 58%).

  • Staffing limitations, not many staff members involved in stewardship (9, 75%).

  • Develop institution-specific antimicrobial stewardship guidelines and standards (6, 50%).

  • Improve antimicrobial stewardship dashboard and data reporting (4, 33%).

  • Improve antimicrobial stewardship collaboration with hospital leadership (4, 33%).

  • Educate healthcare personnel on antibiotic risks/benefits and resistance pattern emergence or microbiology result interpretation (5, 46%).

  • Review antibiotics in electronic health record order sets; remove or switch to narrower spectrum where appropriate (4, 36%).

  • Evaluate antibiotic use in patients with suspected sepsis (1, 9%).

  • Track and report antibiotic use and appropriateness data (2, 18%).

Diagnostic stewardship
  • Adherence to Electronic Health Record C. difficile testing guidelines (10, 83%).

  • Reduce inappropriate testing through education interventions, hard stops and strict testing criteria (9, 75%).

  • Clinical staff engaged and collaborate with microbiology laboratory or within unit on testing procedures (6, 50%).

  • C. difficile rates tracked, monitored and shared with staff (3, 25%).

  • C. difficile testing does not adhere to two-step guidelines or ordering protocols regarding stool, hard stops or meeting testing criteria (9, 75%).

  • Improper urine culture or urinalysis guidance (7, 58%).

  • C. difficile rates and feedback not reported to providers (5, 42%).

  • Poor ordering protocols and guidance within the microbiology lab and nursing staff (5, 42%).

  • Educate on appropriate indications for C. difficile testing or implement best practice alerts and hard stops (11, 100%).

  • Change C. difficile testing type or testing protocol in microbiology laboratory (5, 46%).

  • Data tracking and reporting (eg, isolation orders, prescriptions, testing frequency or clinical decision support adherence) (4, 36%).

  • Changes to reporting patient symptoms or test results (2, 18%).

  • Programme sources: site visit feedback reports for strengths and opportunities; intervention implementation plans for selected interventions.

  • *One participating hospital was missing an intervention implementation plan.

  • PPE, personal protective equipment; SPARC, Statewide Prevention and Reduction of C. difficile.