Nash notes that "Although staff was doing a good job, each person was doing it in their own way. We began a more streamlined approach, and we went to a two-step cleaning process where you clean once and then a second time in isolation rooms."
The two-step process was helpful in mitigating oversights. For example, if an environmental service employee wiped down one bed rail and then became distracted, he or she may have forgotten to wipe the other rail. By having to clean every surface twice, this oversight becomes less likely. And the physical act of wiping—rather than merely spraying a cleaning product—is especially critical with C. diff.
"It used to be all about the product and we thought if you were using a good product you wouldn't have to be concerned about the healthcare environment," Nash says. "This is an organism where a typical disinfectant doesn't kill it. What we were trying to do with cleaning was not so much kill the bug but remove it."
The Jewish Hospital–Mercy Health in Cincinnati also focused on environmental cleaning when its C. diff incident rate reached a record high in 2009. Though the 209-staffed-bed hospital did not have the NAP1 strain, its C. diff rate was particularly alarming because the organization cares for a high volume of elderly patients, so leaders formed a task force to quickly bring down infections.
In 2009 the hospital's C. diff incidence rate was 25.27 per 10,000 patient days. Quality leaders set an initial target of a 10% reduction, with a goal of 22.74.
The hospital formed a task force made up of nurses, physicians, administrators, and staff from infection prevention, pharmacy, and environmental services.
"The task force focused on the units with highest rates of infection," says Azalea Wedig, infection preventionist. "We did a risk assessment, brainstormed, and assessed and decided to target three areas—the broad spectrum antibiotic use, environmental cleaning, and standardization of clinical care."