TAP C. difficile infection (CDI) Implementation Guide: Links to Example Resources

Engagement of Leadership, Champions, and Staff

• Engage the Senior Executive Module
  Module with multiple tools focused on the roles and responsibilities of senior executives, including checklists for senior leaders and board members, from the Agency for Healthcare Research and Quality (AHRQ)
• Prevent and Manage Infections Safely: C. difficile Leadership Fact Sheet [PDF – 3 pages]
  Information about the importance of promoting prevention of C. difficile for nursing home leadership, from Advancing Excellence in America’s Nursing Homes
• Unit/Service Leader Checklist to Improve Hand Hygiene [PDF – 1 page]
  Checklist of strategies that leaders can use to improve hand hygiene on a unit/service, from Johns Hopkins University
• Infection Prevention Champion
  Informational webpage and accompanying PDF to aid partners in the identification and guidance of infection prevention champions, from CDC
• CEO and Senior Leader Checklist
  Checklist for facility senior leadership for goal setting and project management, from AHRQ
• Presentation to Nurse Manager & Case Manager (or Unit Leader)
  Presentation addressing the role of the nurse manager, from AHRQ
• Building Business Case for Infection Prevention Training Module
  Training on developing a business case for infection prevention, including rationale, resources, and a plan for presenting to leadership, from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. Continuing Education (CE) credit available
• Strategies for Preventing HAIs Training Module
  Training on engaging leadership, physicians, nurses, and environmental services managers in infection prevention, from HRET and CDC’s STRIVE Infection Control Training. CE credit available
• CDI Guide to Patient Safety (GPS) Tool [PDF – 27 pages]
  Tool for examining CDI prevention resources and activities along with guidance for improving areas identified. Includes guidance and resources for establishing a staff member with dedicated time for CDI prevention activities and a physician champion (pages 7-10), from HRET

Staff Training and Competency/Skills Assessments

Tools for CDI Prevention Workgroup

• Competency Based Training, Audits and Feedback Modules
  Training modules covering the design of competency-based training (Module CBT 101), use of audits, and giving effective feedback, from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. CE available if all 3 modules completed
• C. difficile 101 for Nurses [PDF -10 pages]
  Presentation slide set to assist with educating nurses about C. difficile infections, from John Hopkins University
• Quick Observation Tools (QUOTS)
  Infection prevention observation tools arranged by themes (e.g. transmission-based precautions, device-associated infections, high-level disinfection), to be used by healthcare providers in various facility locations, from CDC and  the Association of Professionals in Infection Control and Epidemiology (APIC)
• Rochester Patient Safety Collaborative C. difficile Toolkit [PDF – 31 pages]
  Toolkit for the prevention of C. difficile infections containing resources and information on implementation of infection prevention policies, including Contact Precautions and Environmental Cleaning, from the Rochester Patient Safety Collaborative
• Prevention Strategies for CDI Training Modules
  Training modules on the prevention of CDI, including antibiotic stewardship, lab testing, preventing transmission, and monitoring compliance, from HRET and CDC’s STRIVE Infection Control Training. CE credit available if all 6 modules completed
• SBAR Communication Tool: Situation-Background-Assessment-Recommendation
  Framework for communication between members of the healthcare team, from the Institute for Healthcare Improvement
• Clostridioides difficile Roadmap
  Assessment of hospital CDI infection prevention program, including resources on surveillance, early detection and appropriate testing, isolation precautions, environmental cleaning, and antibiotic stewardship, from the Minnesota Hospital Association
• Example Use of the Plan Do Study Act Framework to Improve C. difficile Testing
  Article describing an example use of the Plan Do Study Act Framework to improve C. difficile testing in a Veterans Administration (VA) medical center, from the VA Quality Scholars Program
• Competency Check versus Observational Audit [PDF – 2 pages]
  Fact sheet describing the differences between competency/skills checks and observational audits, from the Agency for Healthcare Research and Quality (AHRQ)

Hand Hygiene Training and Competency/Skills Assessment

• Hand Hygiene Interactive Training Course
  Course and promotional materials that review key concepts of hand hygiene and Standard Precautions, from the CDC
• Hand Hygiene: Why, How & When? [PDF – 7 pages]
  Guidance on hand hygiene with graphics depicting proper technique and moments for hand hygiene, from the World Health Organization (WHO)
• Hand Hygiene and Gloving Competency Assessment
  Quiz about hand hygiene and gloving practices that aligns with CDC and WHO guidelines, from Colorado Department of Public Health and Environment and partners
• How to Hand Wash Poster [PDF – 1 page]
  Poster depicting proper procedure for hand washing, from WHO
• Hand Hygiene Competency Validation [PDF – 1 page]
  Example form used to assess competency of hand hygiene by return demonstration, from Statewide Program for Infection Control and Epidemiology from the University of North Carolina (SPICE UNC)
• Hand Hygiene Training Modules
  Training modules covering the importance of hand hygiene, monitoring hand hygiene adherence, and common barriers to performing hand hygiene, from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. CE credit available if all 3 modules completed
• Clean Hands Count Campaign
  Promotional materials including posters, factsheets, and brochures on hand hygiene for providers and patients. Available in both English and Spanish, from the CDC

Personal Protective Equipment Training and Competency/Skills Assessment

• CDC Personal Protective Equipment Use Poster [PDF – 45 pages]
  Poster displaying proper method and sequence for donning and removing personal protective equipment (PPE), from the CDC
• Competency Check versus Observational Audit [PDF – 2 pages]
  Fact sheet describing the differences between competency/skills checks and observational audits, from the Agency for Healthcare Research and Quality (AHRQ)
• Contact Isolation Skills Competency Checklist [PDF – 2 pages] Competency assessment checklist for donning and doffing PPE and Contact Isolation Precautions, from Nebraska Medicine
• PPE Do’s & Don’ts
  Flyers depicting proper use of gowns, gloves, masks, and respirators in non-surgical healthcare settings, from Association for Professionals in Infection Control and Epidemiology (APIC)
• Personal Protective Equipment Training Modules
  Training modules covering the use of Personal Protective Equipment (PPE), including information on Standard Precautions, Transmission-Based Precautions, and training and auditing staff on PPE use, from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. CE credit available if all 4 modules completed

Environmental Cleaning Training and Skills/Competency Assessment

• Controlling CDI – Environmental Services Cleaning Guidebook [PDF – 45 pages]
  Training guide for environmental services staff with content for general infection control principles and specific recommendations for CDI, from the Minnesota Hospital Association
• Environmental Cleaning Training Modules
  Training modules covering the importance of environmental cleaning and strategies for training and monitoring staff on cleaning and disinfection practices, from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. CE credit available if all 3 modules completed
• EVS and the Battle Against Infection: a Graphic Novel
  Interactive training highlighting the role of environmental services personnel in HAI prevention, from the CDC
• Clostridium difficle Training for Environmental Cleaning Staff
  Training video on Clostridium difficile infection prevention and control for environmental services personnel, from the Oregon Patient Safety Commission
• Environmental Services Room Cleaning Training Video
  Training video on C. difficile for environmental services staff, from the Rochester Patient Safety Collaborative
• Environmental Services Infection Control Strategies
  Training modules and tools for environmental services, from the Association of Professionals in Infection Control and Epidemiology (APIC)

Routine Audits

• iScrub Lite – iPhone/iPod Touch App
  Digital application for recording hand hygiene observations and use of personal protective equipment (PPE), from the University of Iowa
• WHO Hand Hygiene Observation Form [DOC – 3 pages]
  Forms for collecting hand hygiene observations in facilities that have adopted World Health Organization (WHO) hand hygiene guidelines, from World Health Organization (WHO)
• Hand Hygiene Observation Tool [PDF – 2 pages]
  Audit tool for recording healthcare personnel adherence to hand hygiene, from Park Nicollet Methodist Hospital, in partnership with the Minnesota Hospital Association
• Hand and Hygiene/Contact Precautions Monitoring Tool [PDF – 2 pages]
  Monitoring tool for recording healthcare personnel adherence to hand hygiene and Contact Precautions, from United Hospital, in partnership with the Minnesota Hospital Association
• Hand Hygiene/PPE Monitoring Tool for Nursing Homes [PDF – 2 pages]
  Monitoring tool for assessing hand hygiene and Contact Precautions compliance in nursing home settings. This tool can be adapted to align with terminology regarding Transmission-Based Precautions used in the facility (e.g., this example adds Enteric precautions, which is not included in CDC guidelines), from the Health Services Advisory Group (HSAG))
• Isolation Practice Checklist [PDF – 1 page]
  Checklist for assessing performance of Contact Isolation procedures, from the Rochester Patient Safety Collaborative
• Quick Observation Tools (QUOTS)
  Infection prevention observation tools arranged by themes (e.g. transmission-based precautions, device-associated infections, high-level disinfection), to be used by healthcare providers in various facility locations, from CDC and the Association of Professionals in Infection Control and Epidemiology (APIC)
• Measuring Hand Hygiene Adherence: Overcoming the Challenges [PDF – 234 pages]
  Comprehensive manual about hand hygiene programs, including Examples of Measurement Tools starting on pg. 129, from The Joint Commission and partners
• Hand Isolation Hygiene Audit for Patient Care Areas [PDF – 1 page]
  Audit tool for recording healthcare personnel adherence to hand hygiene, from University of Minnesota Medical Center in partnership with the Minnesota Hospital Association
• Options for Evaluating Environmental Cleaning
  Elements of programs to assess environmental cleaning processes for HAI prevention, including CDC Environmental Checklist for Monitoring Terminal Cleaning and spreadsheet for data entry and scoring, from CDC
• Environmental Cleaning and Disinfection Audit [PDF – 1 page]
  Example tool developed to assist with the observation of environmental cleaning practices, from the California Department of Public Health (CDPH)
• C. difficile Collaborative Non-ICU Environmental Cleaning Checklist [PDF – 1 page]
  Example list of items to be cleaned by environmental staff. Resource can be used as an audit for observation of room cleaning procedures, from the Rochester Patient Safety Collaborative.
• C. difficile Collaborative ICU Environmental Cleaning Checklist [PDF – 1 page]
  Example list of items to be cleaned by environmental staff in intensive care unit settings. Resource can be used as an audit for observation of room cleaning procedures, from the Rochester Patient Safety Collaborative.
• C. difficile Collaborative ATP Bioluminescence Checklist [PDF – 1 page]
  Example checklist for monitoring environmental cleaning using ATP bioluminescence, from the Rochester Patient Safety Collaborative
• CDI Guide to Patient Safety (GPS) Tool [PDF – 27 pages]
  Tool for examining CDI prevention resources and activities, along with guidance for improving areas identified. Strategies for EVS auditing and feedback on pages 19-21, from HRET
• Competency Check versus Observational Audit [PDF – 2 pages]
  Fact sheet describing the differences between competency/skills checks and observational audits, from the Agency for Healthcare Research and Quality (AHRQ)
• Competency Based Training, Audits and Feedback Modules
  Training modules covering the design of competency-based training, use of audits (Module CBT 102), and giving effective feedback, from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. CE credit available if all 3 modules completed

Feedback

• NHSN Resources for MDRO and C. difficile Infection Module
  Protocols and training about the National Healthcare Safety Network (NHSN) and collection of CDI incidence data for reporting and feedback, from the CDC
• CDI Cause Analysis
  Worksheet for reviewing CDI cases and adherence to facility policies and practices, including antibiotic review log, from the Massachusetts Coalition for the Prevention of Medical Errors
• C. difficile Infection Case Review Tool [PDF – 4 pages]
  Example case review form for C. difficile infections, from the Minnesota Hospital Association
• MRSA Bacteremia and C. difficile LabID Events SIR Report in NHSN [PDF – 7 pages] Instructions from the National Healthcare Safety Network to create, modify, and interpret a C. difficile Standardized Infection Ratio (SIR) table, from CDC
• Arizona Antibiogram Toolkit [PDF – 30 pages]
  Guidance on preparing an antibiogram and ideas for educating providers about reading and interpreting the antibiogram, from the Arizona Department of Health Services
• Concise Antibiogram Toolkit [PDF – 5 pages] Guidance for facilities on creating and interpreting an antibiogram, from the Agency for Healthcare Research and Quality (AHRQ)
• Competency Based Training, Audits and Feedback Modules
  Training modules covering the design of competency-based training, use of audits, and giving effective feedback (Module CBT 103), from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. CE credit available if all 3 modules completed.

• Core Elements of Hospital Antibiotic Stewardship Programs [PDF – 40 pages]
  Baseline policies and practices for stewardship activities in acute care and long term acute care, including an Antibiotic Stewardship Program Assessment Tool (pg. 26), from the CDC
• Checklist of Core Elements in Antibiotic Stewardship for Long Term Care [PDF – 3 pages]
  Checklist to be used as a baseline assessment of policies and practices and as a guide for expanding stewardship activities in nursing homes, from the CDC
• Checklist of Core Elements in Antibiotic Stewardship for Outpatient Clinics [PDF – 2 pages]
  Checklist to be used as a baseline assessment of policies and practices and as a guide for expanding stewardship activities in outpatient care facilities, from the CDC
• Antibiotic Stewardship Implementation Resources
  Resources to assist in the implementation of hospital antibiotic stewardship programs, including guidelines, assessment tools, conceptual models, and a sample inter-facility infection control transfer form, from CDC
• Antimicrobial Stewardship Program Toolkit: Examples for Program Implementation
  Online toolkit developed to provide support to hospitals for the implementation of antimicrobial stewardship programs, from the California Department of Public Health (CDPH)
• National Quality Partners Playbook: Antibiotic Stewardship in Acute Care
  Practical strategies and suggestions for organizations committed to implementing antibiotic stewardship programs, aligning with the CDC’s Core Elements of Hospital Antibiotic Stewardship Programs, from the National Quality Forum
• Blood Culture Contamination [PDF – 3 pages]
  Resource to assist antibiotic stewardship and infection control programs working with microbiology laboratories in designing and implementing interventions that decrease blood culture contamination rates, from CDC
• Key Activities and Roles for Microbiology Laboratory Staff in Antibiotic Stewardship Programs [PDF – 5 pages]
  Resource outlining the ways in which microbiology laboratory staff can impact antibiotic stewardship programs, from CDC
• ERASE C. difficile Project Antibiotic Stewardship toolkit [PDF – 76 pages]
  Toolkit designed to assist hospital leadership in developing an effective antibiotic stewardship program, from the Agency for Healthcare Research and Quality (AHRQ )
• Acute Care Hospital Antibiotic Stewardship Toolkit
  Toolkit for improving antibiotic use in hospitals, including resources such as a team antibiotic review form, antibiotic time out tool, and a video describing the role of nurses in antibiotic stewardship, from the Agency for Healthcare Research and Quality (AHRQ)

Provider and Nurse Education

• CDC Antibiotic Stewardship Training Series
  Training modules designed to educate clinicians on the appropriate use of antibiotics. Includes content on antibiotic stewardship in outpatient settings, dentistry, emergency departments, hospitals and nursing homes, from the CDC. CE credit available
• Wake Forest School of Medicine Antimicrobial Stewardship Curriculum
  Antibiotic Stewardship curriculum with didactic lectures, facilitator notes/guides, audio recordings, and group activities, from Wake Forest School of Medicine
• Antibiotic Prescribing and Use in Doctor’s Offices-Continuing Education and Resources
  Continuing education and informational resources on antibiotic stewardship for healthcare professionals, from the CDC
• Prevention Strategies for CDI Training Modules- Antibiotic and Lab Testing Stewardship
  Training modules on the prevention of CDI, including antibiotic stewardship (Module CDI 102), from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. CE credit available if all 6 modules completed
• Toolkit to Enhance Nursing and Antibiotic Stewardship Partnership
  Comprehensive toolkit to enhance nursing antibiotic stewardship, including additional resources such as facilitator guides, implementation checklist and framework, and C. difficile educational materials for nurses, from Johns Hopkins University
• Integrating Bedside Nurses into Antibiotic Stewardship [PDF – 6 pages]
  Article describing a practical approach to engaging nurses in antibiotic stewardship programs. Includes perceived barriers to antibiotic stewardship by nurses and potential solutions (Table 1) and four moments for antibiotic decision making adapted for nursing (Box 3), from Johns Hopkins University
• Getting Nurses Involved in Stewardship Efforts Video
  Video describing how two hospitals worked to engage nurses in antibiotic stewardship activities, from Society for Healthcare Epidemiology of America (SHEA)
• Role of Registered Nurses in Hospital Antibiotic Stewardship Practices [PDF – 14 pages]
  White Paper detailing the role of registered nurses in hospital antibiotic stewardship practices, including an outline of how existing roles/activities of nurses align with antibiotic stewardship activities (pgs. 6-8), from the American Nurses Association and CDC

Patient Education

• Prescribed an Antibiotic in the Hospital for an Infection [PDF – 2 pages]
  A factsheet for patients or caregivers about antibiotics prescribed in the hospital, from the CDC
• Preventing the Spread of C. diff at Home [PDF – 1 page]
  Handout summarizing helpful tips for patients on how to prevent the spread of C. difficile when at home, from the CDC
• C. diff Risk: How to Help Your Loved One [PDF – 1 page]
  Handout for family members of patients at risk for developing CDI, including tips on how to prevent infection in a healthcare setting and at home, from the CDC
• Recognizing C. diff at Home (Flyer 8.5×11) [PDF – 2 pages]
  Printable flyer that lists CDI risk factors and symptoms to watch for at home, including a Bristol Stool Chart to help patients and family members identify stool types, from the CDC
• Recognizing C. diff at Home (Pocket Card 4×6) [PDF – 2 pages]
  Printable pocket card that lists CDI risk factors and symptoms to watch for at home, including a Bristol Stool Chart to help patients and family members identify stool types, from the CDC
• Choosing Wisely: Antibiotic Treatment in the Hospital [PDF – 2 pages]
  Patient education on antibiotic treatment in the hospital, from the American Board of Internal Medicine Foundation and SHEA
• CDI Quick Facts [PDF – 2 pages]
  Patient education on prevention of CDI, including information on the risk of CDI with antibiotics, from the Indiana State Department of Health
• Antibiotic Prescribing and Use in Doctor’s Offices-Materials and References
  Materials and references for patient education on antibiotic prescribing and use, from the CDC

Monitoring Antibiotic Use

• Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship: Possible Methods for Evaluating Antibiotic Use
  Table of possible metrics to use for measurement and evaluation of antibiotic use, from the Agency for Healthcare Research and Quality (AHRQ)
• Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship: Medication Use Evaluation Template
  Sample template for reviewing antibiotic use patterns, including graphic comparisons over time, from AHRQ
• Antibiotic Streamlining – Sample Pharmacist’s Daily Routine [PDF – 2 pages]
  Sample pharmacist’s daily routine for reviewing and streamlining antibiotic use, from the Society for Healthcare Epidemiology of America (SHEA)
• Arizona Antibiogram Toolkit [PDF – 30 pages]
  Guidance on preparing an antibiogram and ideas for educating providers about reading and interpreting the antibiogram, from the Arizona Department of Health Services
• Concise Antibiogram Toolkit [PDF – 5 pages]
  Guidance for facilities on creating and interpreting an antibiogram, from AHRQ
• Surveillance for Antimicrobial Use and Antimicrobial Resistance Options
  Compilation of NHSN resources for AUR module reporting, including training, protocols, data validation and collection, and analysis for acute care facilities
• NHSN Annual Hospital Survey – Antibiotic Stewardship Practices Section [PDF – 14 pages]
  Partners are encouraged to complete the Antibiotic Stewardship Practices questions (beginning on page 8) within the NHSN Annual Hospital Survey with a staff member who is most knowledgeable about the facility’s antibiotic stewardship practices (e.g., pharmacist or physician stewardship lead) as an opportunity to review their stewardship program. Partners are also encouraged to confirm their most recent NHSN Annual Hospital Survey responses align with their current stewardship practices.

• Algorithms for Prevention and Management of Clostridium difficile Infections in Long-term Care Facilities [PDF – 8 pages]
  Decision-making strategies for enhancing early recognition, testing, and isolation of patients with CDI in long-term care facilities, from the Minnesota Department of Public Health
• Prevention Strategies for CDI Training Modules- Antibiotic and Lab Testing Stewardship
  Training modules on the prevention of CDI, including diagnostic stewardship (Module CDI 102), from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. CE credit available if all 6 modules completed
• Bristol Stool Form Scale
  Scale tool that provides an objective way to differentiate between various types of stool forms and recognize diarrhea, from the National Institutes of Health (NIH)
• Guidance to Providers: Testing for C. difficile Infection [PDF – 4 pages]
  Recommendations for CDI testing, including a sample diagnostic algorithm (pg. 2), from Vanderbilt University Medical Center
• Inter-facility Infection Control Transfer Form [PDF – 3 pages]
  Comprehensive form including current antibiotics, vaccines, isolation precautions and infection/colonization history, from CDC and the Utah Department of Health
• Inter-facility Infection Prevention Transfer Form [PDF – 1 page]
  Concise, 1-page form focusing on isolation precautions and infection/colonization history, from the Cook County (IL) Department of Public Health.
• INTERACT Tips for Engaging Hospitals in Transition Programs [PDF – 3 pages]
  Information and checklist for engaging hospitals in transition programs, from Florida Atlantic University
• Example Ticket to Ride/Ticket to Return for Patient Transfers [PDF – 2 pages]
  Example form to help facilitate sharing of patient information upon transfer, from University of Nebraska Medical Center
• INTERACT Skilled Nursing Facility/Nursing Home to Hospital Transfer Form [PDF – 2 pages]
  Example form for transfers between long term care facilities and hospitals, from Florida Atlanta University
• Example Best Practice Alert for Appropriate C. difficile Testing [PDF – 1 page]
  Example alert for possible inappropriate testing orders, from the Rochester Patient Safety Collaborative
• Example Policy for Stool Testing for C. difficile [PDF – 1 page]
  Example policy for indications for specimen collection and initiation of Contact Precautions, from the Rochester Patient Safety Collaborative
• Example Evaluation of CDI Testing and Ordering Practices [PDF – 6 pages]
  Example evaluation process for understanding C. difficile testing and ordering practices, from the Minnesota Hospital Association
• CDI Guide to Patient Safety (GPS) Tool [PDF – 27 pages]
  Tool for examining CDI prevention resources and activities along with guidance for improving areas identified. Pages 26-27 include content on educating providers on when to order C. difficile tests and the role of nurses in appropriate testing, from HRET
• Example Diarrhea Decision Tree [PDF – 2 pages]
  Example decision tree for C. difficile testing and implementation of Contact Precautions, from Great Plains Quality Improvement Network
• C. difficile Infections & Diagnostic Stewardship [PDF – 39 pages]
  Presentation on CDI epidemiology, prevention, and diagnostic stewardship, from the Georgia Department of Public Health

• Creative Hand Hygiene Programs to Motivate Staff
  PowerPoint presentation that places hand hygiene activities within theoretical frameworks supporting fun and interactive measures to improve hand hygiene, by Maureen Spencer, RN M. ED, CIC, New England Baptist Hospital
• Controlling CDI: Hand Hygiene Environmental Assessment Tool [DOCX – KB]
  Assessment tool for placement and use of hand hygiene products in clinical units, including patient rooms, from the Minnesota Hospital Association
• Algorithms for Prevention and Management of Clostridium difficile Infections in Long-term Care Facilities [PDF – 8 pages]
  Algorithm for implementing Contact Precautions for patients with CDI (pg. 4), from the Minnesota Department of Public Health
• Hand Hygiene Training Modules
  Training modules covering the importance of hand hygiene, monitoring hand hygiene adherence, and common barriers to performing hand hygiene, from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. CE credit available if all 3 modules completed
• Prevention Strategies for CDI Training Modules- Preventing Transmission
  Training modules on the prevention of CDI, including information on Contact Precautions (Module CDI 103), from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. CE credit available if all 6 modules completed
• How to Hand Wash Poster [PDF – 1 page]
  Poster summarizing how to perform hand hygiene and wash hands when visibly soiled, from the World Health Organization.
• Personal Protective Equipment (PPE) Do’s and Don’ts
  Infographics for healthcare professionals listing on how to use PPE in non-surgical settings, from the Association for Professionals in Infection Control and Epidemiology (APIC)
• Transmission-Based Precautions
  Information on Transmission-Based Precautions and example precaution signs, from the CDC
• Example Contact Precautions sign for C. difficile [PDF – 1 page]
  Example Contact Precautions sign prompting use of a sporicidal agent for cleaning and disinfection, which can be posted outside rooms of patients with C. difficile, from CDC
• Duration of Contact Precautions for Acute-Care Settings
  Expert guidance and recommendations on the duration of Contact Precautions in acute care hospitals, from the Society for Healthcare Epidemiology of America (SHEA)
• Isolation Practice Checklist [PDF – 1 page]
  Checklist for assessing performance of Contact Isolation procedures, from the Rochester Patient Safety Collaborative

Education of Patients/Families and Visitors

• C. difficile Information for Patients
  General information about C. difficile and risks associated with antibiotic use for patients, from the CDC
• Preventing the Spread of C. diff at Home [PDF – 1 page]
  Handout summarizing helpful tips for patients on how to prevent the spread of C. difficile when at home, from the CDC
• C. diff Risk: How to Help Your Loved One [PDF – 1 page]
  Handout for family members of patients at risk for developing CDI, including tips on how to prevent infection in a healthcare setting and at home, from the CDC
• Recognizing C. diff at Home (Flyer 8.5×11) [PDF – 2 pages]
  Printable flyer that lists CDI risk factors and symptoms to watch for at home, including a Bristol Stool Chart to help patients and family members identify stool types, from the CDC
• Recognizing C. diff at Home (Pocket Card 4×6) [PDF – 2 pages]
  Printable pocket card that lists CDI risk factors and symptoms to watch for at home, including a Bristol Stool Chart to help patients and family members identify stool types, from the CDC
• X-Plain Patient Education: C. difficile Infections [PDF – 6 pages]
  Handout summarizing CDI information for patients, including proper hand hygiene for prevention of transmission (pg. 5), from The Patient Education Institute
• Guide to Patient and Family Engagement in Hospital Quality and Safety
  Toolkit for engaging patients and families in efforts to improve the quality and safety of healthcare, from AHRQ
• Hand Hygiene Saves Lives
  Video illustrating how patients can play an active role in reminding healthcare providers to practice hand hygiene, from the CDC
• Clean Hands Count Campaign
  Promotional materials including posters, factsheets, and brochures on hand hygiene for providers and patients. Available in both English and Spanish, from the CDC
• Patient and Family Engagement Training Module
  Training on engaging patients and families in infection prevention, from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. CE credit available

• EPA Registered Antimicrobial Products Effective against C. difficile Spores
  Listing of disinfectant products with sporicidal activity against C. difficile, from the Environmental Protection Agency (EPA)
• Not Just A Maid Service
  Video describing how two hospitals engaged their environmental service workers to decrease transmission of C. difficile infection (CDI), from the Illinois Department of Public Health
• Algorithms for Prevention and Management of C. difficile Infections in Long-term Care Facilities [PDF – 8 pages]
  Instructions for environmental cleaning and disinfection for patients with CDI (pg. 7), from the Minnesota Department of Public Health
• Reduce Risk from Surfaces: CDC Core Components of Environmental Cleaning and Disinfection in Hospitals
  Framework describing the core components of a comprehensive cleaning and disinfection program, including information on education and evaluation, from the CDC
• Equipment Cleaning Guidelines Template [PDF – 6 pages]
  Example of how to delineate roles for cleaning equipment. The template includes what to clean, when to clean, who cleans, and type of cleaner. Developed by the Rochester Patient Safety Collaborative.
• C. difficile Collaborative Non-ICU Environmental Cleaning Checklist [PDF – 1 page]
  Example list of items to be cleaned by environmental staff. Resource can be used as an audit for observation of room cleaning procedures. Developed by the Rochester Patient Safety Collaborative.
• C. difficile Collaborative ICU Environmental Cleaning Checklist [PDF – 1 page]
  Example list of items to be cleaned by environmental staff in intensive care unit settings. Resource can be used as an audit for observation of room cleaning procedures. Developed by the Rochester Patient Safety Collaborative
• Environmental Services Infection Control Strategies
  Training modules and tools for environmental services, from the Association of Professionals in Infection Control and Epidemiology (APIC)
• Environmental Cleaning and Disinfection Audit [PDF – 1 page]
  Example tool developed to assist with the observation of environmental cleaning practices, from the California Department of Public Health (CDPH)
• EVS and the Battle Against Infection: a Graphic Novel
  Interactive training highlighting the role of environmental services personnel in HAI prevention, from the CDC
• Cleaning and Disinfecting a Resident Room in Long-Term Care
  Video demonstrating daily room cleaning for long-term care settings, from the Chicago Department of Public Health
• Barriers to Environmental Cleaning
  Information and resources on effective cleaning and disinfection practices, from the California Department of Public Health
• Clostridium difficile Training for Environmental Cleaning Staff
  Training video on Clostridium difficile infection prevention for environmental services personnel, from the Oregon Patient Safety Commission
• Improvement in Hospital Cleaning Associated with Education for Environmental Services Workers [PDF – 6 pages]
  Article describing the introduction of an educational program on infection prevention strategies for environmental services workers, from the Society for Healthcare Epidemiology of America
• Environmental Cleaning Training Modules
  Training modules covering the importance of environmental cleaning and strategies for training and monitoring staff on cleaning and disinfection practices, from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. CE credit available if all 3 modules completed
• Environmental Services Room Cleaning Training Video
  Training video on C. difficile for environmental services staff, from the Rochester Patient Safety Collaborative

• C. difficile Infection (CDI) Prevention Collaborative Laboratory Testing Information [PDF – 325 KB]
  Overview of C. difficile laboratory tests with table comparing tests on pg. 2, from the Florida Department of Health
• A Practical Guidance Document for the Laboratory Detection of Toxigenic C.  difficile [PDF – 3 pages]
  Recommended practices and sample algorithms for C. difficile laboratory testing, from the American Society for Microbiology (ASM)
• Guidance to Providers: Testing for C. difficile Infection [PDF – 4 pages]
  Recommendations for CDI testing, including a sample diagnostic algorithm (pg. 2), from Vanderbilt University Medical Center
• Bristol Stool Form Scale
  Scale tool that provides an objective way to differentiate between various types of stool forms and recognize appropriate diarrhea for testing, from the National Institutes of Health (NIH)
• Example Evaluation of CDI Testing and Ordering Practices [PDF – 6 pages]
  Example evaluation process for understanding C. difficile testing and ordering practices, from the Minnesota Hospital Association