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

Engagement of Leadership, Champions, and Staff

• Engage the Senior Executive Module – Comprehensive Unit-based Safety Program (CUSP) Toolkit
  Tools focused on engaging and defining the roles and responsibilities of senior executives in a quality improvement initiative, from the Agency for Healthcare Research and Quality (AHRQ)
• Clostridium difficile Infection (CDI) Toolkit – A Healthcare Professional’s Guide to Preventing CDIs
  Compilation of guidelines, recommendations, and tools for reducing CDI, including general strategies to engage Atom Alliance
• 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
• Road Map to a Comprehensive Clostridium difficile Infection (CDI) Prevention Program [PDF – 10 pages]
  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 – 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

Empowering Staff

• Stop the Line for Patient Safety Initiative
  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 [DOC – 2 pages]
  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

• Clostridium difficile Infection (CDI) Toolkit – A Healthcare Professional’s Guide to Preventing CDIs
  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
• New Mexico Clostridium difficile Prevention Project Nursing Training Module
  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

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 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)
• Clean Care is Safer Care – Tools for Training and Education Tools for hand hygiene training and education for healthcare personnel, including slide presentations, videos, brochures, and posters, from the World Health Organization (WHO)
• Hand Hygiene and Gloving Competency Assessment Quiz about hand hygiene and gloving practices that aligns with CDC and World Health Organization (WHO) guidelines, from Colorado Department of Public Health and Environment and partners

Personal Protective Equipment Training and Competency Assessment

• CDC Personal Protective Equipment Use Poster [PDF – 45 pages]
  Poster displaying and describing proper method and sequence for donning and removing personal protective equipment (PPE), from CDC
• Contact Isolation Skills Competency Checklist [PDF – 2 pages]
  Competency assessment checklist for donning and doffing PPE and contact isolation precautions, from the American Association of Nurse Assessment Coordination

Environmental Cleaning Training and 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
• HAI Train-The-Trainer: The Role of Environmental Cleaning in Preventing HAIs [WMV]
  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

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
  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
• Clostridium difficile Infection (CDI) Toolkit – A Healthcare Professional’s Guide to Preventing CDIs
  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 – 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
• Reducing C. difficile Infections Toolkit [PDF – 59 pages]
  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)

Feedback

• NHSN Resources for MDRO and C. difficile Infection Module
  Protocols and training for National Healthcare Safety Network and the collection of CDI incidence data for reporting and feedback, from 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
• Demo Exercise: LabID Event SIR [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 Scripting
  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 – 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)

• Checklist for Core Elements of Hospital Antibiotic Stewardship Programs [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 CDC
• Checklist of Core Elements in Antibiotic Stewardship for Long Term Care [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 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 CDC
• 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
• Antimicrobial Stewardship Toolkit
  Best practices from an Antimicrobial Stewardship Collaborative, from the Greater New York Hospital Association and the United Hospital Fund
• 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 the Agency for Healthcare Research and Quality (AHRQ)
• Antibiotic Streamlining – Sample Pharmacist’s Daily Routine [PDF – 128 KB]
  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 – 76 KB]
  A template form that antibiotic stewardship committees can use to evaluate antibiotic use, from the Society for Healthcare Epidemiology of America (SHEA)
• CDI Awareness Campaign Challenge #2: Antibiotic Stewardship [PDF – 7 pages]
  Self-assessment to help facilities assess their current state of antibiotic stewardship and choose action oriented challenges to address from Kepro Ohio Quality Improvement Organization
• 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)
• 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
• Evidence to Support Antibiotic Stewardship
  Videos and tools to support appropriate antibiotic use, from CDC
• Prescribed an Antibiotic in the Hospital for an Infection [PDF – 2 pages]
  A factsheet for patients or caregivers about antibiotics prescribed in hospital, from CDC

• Algorithms for Prevention and Management of Clostridium difficile Infections in Long-term Care Facilities [PDF – 11 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
• C. difficile Infection Change Package: Preventing C. difficile Transmission and Infection [PDF – 25 pages]
  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 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 – 3 pages]
  Recommendations for CDI testing, including a sample diagnostic algorithm (pg. 2), from Vanderbilt University Medical Center
• Inter-facility Infection Control Transfer Form [PDF – 2pages]
  Sample form to assist in fostering communication of infectious disease status during transitions of care, from CDC and the Utah Department of Health
• Inter-facility Infection Prevention Transfer Form [PDF – 1 page]
  Sample form for communication of infectious disease status, including CDI, during transitions of care, from the Cook County (IL) 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. 5), from the Minnesota Department of Public Health
• Clostridium difficile Infection (CDI) Toolkit – A Healthcare Professional’s Guide to Preventing CDIs
  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
• Standardization of Isolation Precaution Signage Toolkit [PDF – 2 MB]
  An implementation toolkit on the Standardization of Isolation Precaution Signage that contains FAQs, sample policies, and education materials. The sign for Contact Enteric Precautions (e.g. Clostridium difficile) can be downloaded [PDF – 2 pages] from the Washington State Hospital Association.
• 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)

Education of Patients/Families and Visitors

• Your Roadmap to Engaging Patients and Families in Hand Hygiene [PDF – 189 KB]
  A suite of tools that provide guidance in the implementation of activities to engage patients and families in hand hygiene, from Qualis Health
• FAQs about Clostridium difficile [PDF – 276 KB]
  Fact sheet to educate patients and visitors about CDI, from CDC, the Society for Healthcare Epidemiology of America (SHEA), the Association for Professionals in Infection Control and Epidemiology (APIC), and the American Hospital Association (AHA)
• Clostridium difficile Information for Patients
  General information about C. difficile and risks associated with antibiotic use for patients, includes Spanish language resources, from CDC
• Infection Control: C. difficile
  Patient education materials for control of transmission of C. difficile, with review of hand washing and contact precautions for patients and visitors, from University of Pittsburgh Medical Center
• Clostridium difficile Infection (CDI) Toolkit – A Healthcare Professional’s Guide to Preventing CDIs
  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 – 6 pages]
  Handout summarizing CDI information for patients, including proper hand hygiene for prevention of transmission (pg. 5), from The Patient Education Institute

• EPA Registered Antimicrobial Products Effective against Clostridium 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 CDI, from the Illinois Department of Public Health
• Algorithms for Prevention and Management of Clostridium difficile Infections in Long-term Care Facilities [PDf – 11 pages]
  Instructions for environmental cleaning and disinfection for patients with CDI (pg. 9), from the Minnesota Department of Public Health
• Clostridium difficile Infection (CDI) Toolkit – A Healthcare Professional’s Guide to Preventing CDIs
  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 – 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.

• Clostridium 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 Clostridium difficile [PDF – 767 KB]
  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 – 231 KB]
  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)