TAP C. difficile infection (CDI) Implementation Guide: Links to Example Resources
Disclaimer: The links in the domains below are not mutually exclusive nor do they represent an exhaustive list of all the possible resources available. Furthermore, the links presented do not constitute an endorsement of these organizations or their programs by the Centers for Disease Control and Prevention (CDC) or the federal government, and none should be inferred.
Also refer to the following guidelines:
Strategies to Prevent C. difficile Infections in Acute Care Hospitals: 2014 Updateexternal icon
Other relevant CDC guidelines.
Strategies to Prevent C. difficile Infection in Acute Care Facilities, CDC 2018
Engagement of Leadership, Champions, and Staff
- Engage the Senior Executive Moduleexternal icon
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) - C. difficile Infection (CDI) Toolkit – A Healthcare Professional’s Guide to Preventing CDIsexternal icon
Compilation of guidelines, recommendations, and tools for reducing CDI, including general strategies to engage executive leadership and boards in CDI prevention efforts (pgs. 11-13), from the Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organizations (QIOs) and Atom Alliance - Prevent and Manage Infections Safely: C. difficile Leadership Fact Sheet pdf icon[PDF – 3 pages]external icon
Information about the importance of promoting prevention of C. difficile for nursing home leadership, from Advancing Excellence in America’s Nursing Homes - Road Map to a Comprehensive C. difficile Infection (CDI) Prevention Program pdf icon[PDF – 10 pages]external icon
Facility audit tool for assessment of hospital CDI prevention program, including identification of CDI prevention champions, leadership engagement, and interdisciplinary teams (pg. 3), from the Minnesota Department of Health - Unit/Service Leader Checklist to Improve Hand Hygiene pdf icon[PDF – 1 page]external icon
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 Checklistexternal icon
Checklist for facility senior leadership for goal setting and project management, from AHRQ
Empowering Staff
- Stop the Line for Patient Safety Initiativeexternal icon
Video describing an initiative that empowers staff to speak up if they see a risk to patient safety, from the U.S. Department of Veterans Affairs - Model Stop the Line Policy word icon[DOC – 2 pages]external icon
Sample policy giving all hospital personnel the responsibility and authority to intervene to prevent a patient safety event, from the Minnesota Hospital Association
Staff Training and Competency Assessments
Tools for CDI Prevention Workgroup
- C. difficile Infection (CDI) Toolkit – A Healthcare Professional’s Guide to Preventing CDIsexternal icon
Compilation of evidence-based research and guidelines, recommendations, tools and resources for reducing CDI and other healthcare-associated infections, from the Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organizations (QIOs) and Atom Alliance - Competency Based Training, Audits and Feedback Modules
Training modules covering the design of competency-based training, use of audits, and giving effective feedback, from Health Research & Educational Trust (HRET) and CDC’s STRIVE Infection Control Training. - New Mexico Clostridium difficile Prevention Project Nursing Training Moduleexternal icon
Module intended for nurses, to provide recommendations for practice for patients with CDI; a nursing continuing education certificate is available, from HealthInsight and the New Mexico Hospital Association - 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)
Hand Hygiene Training and Competency 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 icon[PDF – 7 pages]external icon Guidance on hand hygiene with graphics depicting proper technique and moments for hand hygiene, from the World Health Organization (WHO)
- Clean Care is Safer Care – Tools for Training and Educationexternal icon Tools for hand hygiene training and education for healthcare personnel, including slide presentations, videos, brochures, and posters, from WHO
- Hand Hygiene and Gloving Competency Assessmentexternal icon Quiz about hand hygiene and gloving practices that aligns with CDC and WHO guidelines, from Colorado Department of Public Health and Environment and partners
- Hand Washing Poster pdf icon[PDF – 1 page]external icon
Poster depicting proper procedure for hand washing, from WHO - Hand Hygiene Competency Validation pdf icon[PDF – 1 page]external icon
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. - 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 Assessment
- CDC Personal Protective Equipment Use Poster pdf icon[PDF – 45 pages]
Poster displaying proper method and sequence for donning and removing personal protective equipment (PPE), from the CDC - Contact Isolation Skills Competency Checklist pdf icon[PDF – 2 pages]external icon
Competency assessment checklist for donning and doffing PPE and Contact Isolation Precautions, from the American Association of Nurse Assessment Coordination - PPE Do’s & Don’tsexternal icon
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.
Environmental Cleaning Training and Competency Assessment
- Controlling CDI – Environmental Services Cleaning Guidebook pdf icon[PDF – 45 pages]external icon
Training guide for environmental services staff with content for general infection control principles and specific recommendations for CDI, from the Minnesota Hospital Association - HAI Train-The-Trainer: The Role of Environmental Cleaning in Preventing HAIs media icon[WMV]external icon
Video training module discussing best practices for environmental cleaning for prevention of HAIs in the healthcare setting, from the CDC, in collaboration with the Society for Healthcare Epidemiology of America (SHEA) and Avaris Concepts, Inc - 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. - Clostridium difficle Training for Environmental Cleaning Staff
Training video on Clostridium difficle infection prevention and control for environmental services personnel, from the Oregon Patient Safety Commission
Routine Audits
- iScrub Lite – iPhone/iPod Touch Appexternal icon
Digital application for recording hand hygiene observations and use of personal protective equipment (PPE), from the University of Iowa - WHO Hand Hygiene Observation Formword iconexternal icon
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 icon[PDF – 2 pages]external icon
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 icon[PDF – 2 pages]external icon
Monitoring tool for recording healthcare personnel adherence to hand hygiene and Contact Precautions, from United Hospital, in partnership with the Minnesota Hospital Association - C. difficile Infection (CDI) Toolkit – A Healthcare Professional’s Guide to Preventing CDIs external icon
Compilation of guidelines, recommendations, and tools for reducing CDI, including a Hand Hygiene Compliance Audit Tool (pg. 26), from the Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organizations (QIOs) and Atom Alliance - Measuring Hand Hygiene Adherence: Overcoming the Challenges pdf icon[PDF – 234 pages]external icon
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 icon[PDF – 1 page]external icon
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 - Reducing C. difficile Infections Toolkit pdf icon[PDF – 59 pages]external icon
Toolkit based on published guidelines and experiences of the Greater New York Hospital Association / United Hospital Fund C. difficile Collaborative, including Assessment of Current Practices to Reduce CDI Tool (pg. 23), CDI Prevention Checklist (pgs. 27-28), Environmental Cleaning Observations Checklist (pgs. 29-30), Hand Hygiene Monitoring Tool (pgs. 45-47) - Environmental Cleaning Observation Tool pdf icon[PDF – 2 pages]external icon
Tool with checklist for environmental cleaning tasks, from the West Virginia Department of Health and Human Resources
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 Analysisexternal icon
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 - Demo Exercise: LabID Event SIR pdf icon[PDF – 2 pages]
Instructions from the National Healthcare Safety Network to create, modify, and interpret a C. difficile Standardized Infection Ratio (SIR) table, from CDC - Hand Hygiene Compliance Immediate Feedback Scriptingexternal icon
Script for providing immediate feedback during hand hygiene audits, from University of North Carolina (UNC) Health Care and UNC School of Medicine - Arizona Antibiogram Toolkit pdf icon[PDF – 30 pages]external icon
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 icon[PDF – 5 pages]external icon Guidance for facilities on creating and interpreting an antibiogram, from the Agency for Healthcare Research and Quality (AHRQ)
- Checklist for Core Elements of Hospital Antibiotic Stewardship Programs pdf icon[PDF – 24 pages]
Checklist to be used as a baseline assessment of policies and practices and as a guide for stewardship activities in acute and long term acute care, from the CDC - Checklist of Core Elements in Antibiotic Stewardship for Long Term Care pdf icon[PDF – 85 KB]
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 icon[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 - Stewardship Program Examples
Links to hospital stewardship programs at various hospitals, success stories, and an interactive collection of charts and maps summarizing national and subnational data on antimicrobial use and resistance (Resistance Map), from CDC - Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship: Possible Methods for Evaluating Antibiotic Useexternal icon
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 Templateexternal icon
Sample template for reviewing antibiotic use patterns, including graphic comparisons over time, from AHRQ - Antibiotic Streamlining – Sample Pharmacist’s Daily Routine pdf icon[PDF – 128 KB]external icon
Sample pharmacist’s daily routine for reviewing and streamlining antibiotic use, from the Society for Healthcare Epidemiology of America (SHEA) - Drug Use Evaluation Form pdf icon[PDF – 76 KB]external icon
A template form that antibiotic stewardship committees can use to evaluate antibiotic use, from SHEA - Arizona Antibiogram Toolkit pdf icon[PDF – 30 pages]external icon
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 icon[PDF – 5 pages]external icon
Guidance for facilities on creating and interpreting an antibiogram, from AHRQ - National Quality Partners Playbook: Antibiotic Stewardship in Acute Careexternal icon
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 - Prescribed an Antibiotic in the Hospital for an Infection pdf icon[PDF – 2 pages]
A factsheet for patients or caregivers about antibiotics prescribed in hospital, from the CDC - 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 icon[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. - Antimicrobial Stewardship Program Toolkit: Examples for Program Implementationexternal icon
Online toolkit developed to provide support to hospitals for the implementation of antimicrobial stewardship programs, from the California Department of Public Health (CDPH)
- Algorithms for Prevention and Management of Clostridium difficile Infections in Long-term Care Facilities pdf icon[PDF – 8 pages]external icon
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 - C. difficile Infection Change Package: Preventing C. difficile Transmission and Infection pdf icon[PDF – 25 pages]external icon
Compilation of tools, including algorithms for testing and diarrhea decision trees that align with appropriate isolation and testing guidelines (pgs. 23, 24), from the Health Research & Educational Trust (HRET), American Hospital Association (AHA), and Partnership for Patients - Bristol Stool Form Scaleexternal icon
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 icon[PDF – 3 pages]external icon
Recommendations for CDI testing, including a sample diagnostic algorithm (pg. 2), from Vanderbilt University Medical Center - Inter-facility Infection Control Transfer Form pdf icon[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 icon[PDF – 1 page]external icon
Concise, 1-page form focusing on isolation precautions and infection/colonization history, from the Cook County (IL) Department of Public Health. - ERASE C. difficile Project Antibiotic Stewardship toolkit pdf icon[PDF – 76 pages]external icon
Toolkit designed to assist hospital leadership in developing an effective antibiotic stewardship program, from the Agency for Healthcare Research and Quality (AHRQ)
- Creative Hand Hygiene Programs to Motivate Staffexternal icon
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 word icon[DOCX – KB]external icon
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 icon[PDF – 8 pages]external icon
Algorithm for implementing Contact Precautions for patients with CDI (pg. 5), from the Minnesota Department of Public Health - C. difficile Infection (CDI) Toolkit – A Healthcare Professional’s Guide to Preventing CDIsexternal icon
Compilation of guidelines, recommendations, and tools for reducing CDI, including strategies for preventing CDI with hand hygiene (pgs. 19-21), from the Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organizations (QIOs) and Atom Alliance - How to Hand Wash Poster pdf icon[PDF – 1 page]external icon
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’tsexternal icon
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 - Contact Enteric Precaution Signexternal icon
Downloadable Contact Precaution sign from the Washington State Hospital Association - Duration of Contact Precautions for Acute-Care Settingsexternal icon
Expert guidance and recommendations on the duration of Contact Precautions in acute care hospitals, from the Society for Healthcare Epidemiology of America (SHEA)
Education of Patients/Families and Visitors
- Your Roadmap to Engaging Patients and Families in Hand Hygiene pdf icon[PDF – 1 page]external icon
A suite of tools that provide guidance in the implementation of activities to engage patients and families in hand hygiene, from Qualis Health - C. difficile Information for Patients
General information about C. difficile and risks associated with antibiotic use for patients, including Spanish language resources, from the CDC - C. difficile Infection (CDI) Toolkit – A Healthcare Professional’s Guide to Preventing CDIsexternal icon
Compilation of guidelines, recommendations, and tools for reducing CDI, including a Sample Patient/Family Education Q&A form (pg. 24), from the Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organizations (QIOs) and Atom Alliance - X-Plain Patient Education: C. difficile Infections pdf icon[PDF – 6 pages]external icon
Handout summarizing CDI information for patients, including proper hand hygiene for prevention of transmission (pg. 5), from The Patient Education Institute - 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
- EPA Registered Antimicrobial Products Effective against C. difficile Sporesexternal icon
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 icon[PDF – 8 pages]external icon
Instructions for environmental cleaning and disinfection for patients with CDI (pg. 9), from the Minnesota Department of Public Health - C. difficile Infection (CDI) Toolkit – A Healthcare Professional’s Guide to Preventing CDIsexternal icon
Compilation of guidelines, recommendations, and tools for reducing CDI, including strategies for environmental cleaning (pgs. 22-23) and a CDC Environmental Checklist for terminal cleaning (pg. 27), from the Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organizations (QIOs) and Atom Alliance - Equipment Cleaning Guidelines Template pdf icon[PDF – 6 pages]external icon
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 icon[PDF – 1 page]external icon
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. - Environmental Services Infection Control Strategies external icon
Training modules and tools for environmental services, from the Association of Professionals in Infection Control and Epidemiology (APIC) - Environmental Cleaning and Disinfection Audit pdf icon[PDF – 1 page]external icon
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 Cleaningexternal icon
Information and resources on effective cleaning and disinfection practices, from the California Department of Public Health - Environmental Cleaning Observation Tool pdf icon[PDF – 2 pages]external icon
Tool with checklist for environmental cleaning tasks, from the West Virginia Department of Health and Human Resources - Clostridium difficle Training for Environmental Cleaning Staff
Training video on Clostridium difficle infection prevention for environmental services personnel, from the Oregon Patient Safety Commission - Improvement in Hospital Cleaning Associated with Education for Environmental Services Workers pdf icon[PDF – 6 pages]external icon
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.
- C. difficile Infection (CDI) Prevention Collaborative Laboratory Testing Information pdf icon[PDF – 325 KB]external icon
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 icon[PDF – 3 pages]external icon
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 icon[PDF – 231 KB]external icon
Recommendations for CDI testing, including a sample diagnostic algorithm (pg. 2), from Vanderbilt University Medical Center - Bristol Stool Form Scaleexternal icon
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)
Page last reviewed: December 6, 2019