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. Author manuscript; available in PMC: 2018 Jun 1.
Published in final edited form as: Infect Control Hosp Epidemiol. 2017 Mar 27;38(6):639–650. doi: 10.1017/ice.2017.7

Table 2.

Intervention details

First Author Intervention Component Details
Abbett Antibiotic Stewardship Discontinue nonessential antimicrobials when suspected case
Contact Precautions Enhanced; gowns, gloves, alcohol gel before, soap and water after patient contact
Dedicated Equipment Stethoscope in patient rooms
Education- Staff CDI and prompt responses; nurses, doctors, physician assistants, environmental services, and administration
Environmental Cleaning Hyperchlorite disinfectant at discharge
Hand Hygiene Described in contact precautions
Isolation and/or Cohorting Suspected cases in single room
Systems and Workflow Infection control for suspected cases, communication improved between lab and nurses, infection preventionists and environmental services, infection preventionists sent daily CDI list and confirm prevention practices, electronic medical record flagging, standardize CDI treatment
Apisarn-thanarak Contact Precautions Not Specified
Education- Staff Regarding contact precaution
Environmental Cleaning Patient rooms and staff areas cleaned with 10% hypochlorite, carpeted areas cleaned
Hand Hygiene Signage
Bishop Antibiotic Stewardship Prophylactic antibiotics regulated, fluoroquinolones limited
Contact Precautions Limit patient contact to 1 member of surgical team, lab coats provided, glove changes
Environmental Cleaning Terminal cleaning focused on immediate patient environment
Hand Hygiene Before and after gloving, increased education, increased monitoring, facility improvements,
Proton Pump Inhibitor Stewardship Limited to intensive care unit or specific clinical indications
Systems and Workflow Resident rounding to limit staff exposures
Brakovich Environmental Cleaning New cleaning equipment (microfiber mops vs. cotton), decontaminate more frequently, hydrogen peroxide vapor decontamination
Antibiotic Stewardship Lower frequency and duration of antimicrobials, restrict clindamycin and cephalosporin
Education - Staff Hands on training for environmental services
Hand Hygiene Recommend soap and water, reminder stickers, staff and visitors
Isolation and/or Cohorting CDI patient isolate to private room
Contact Precautions Contact precautions for all CDI patients
Systems and Workflow Improved diagnostic testing, cleaning checklist for environmental services staff
Cheng Antibiotic Stewardship Immediate concurrent feedback, and focus on broad-spectrum intravenous antibiotics
Contact Precautions Gloves and gowns
Dedicated Equipment Bedpans and commodes
Education- Staff Train cleaning staff, emphasizing high-touch areas, training ward staff quarterly
Environmental Cleaning Clean rooms twice daily, 1,000 parts per million sodium hypochlorite, curtain change at discharge
Hand Hygiene Soap and water
Isolation and/or Cohorting Nursed as cohort, preferably in single rooms
Guilhar Antibiotic Stewardship Five-day antibiotic stop policy, approval for high-risk antibiotics, surgery prophylaxis changed from cefuroxime to co-amoxiclav or vancomycin
Education- Patient Focus on hand hygiene
Education- Staff Focus on hand hygiene
Environmental Cleaning Sodium-dichloroisocyanurate for environmental cleaning
Hand Hygiene Alcohol gel on rounds, soap/water before and after ward and isolation bays, new sinks
Isolation and/or Cohorting Rapid isolation of diarrheal patients in side rooms or isolation bays
Hanna Contact Precautions Enteric precautions for all diarrheal patients, disposable gowns, gloves in CDI rooms
Dedicated Equipment Mercury thermometers
Education- Staff On-ward sessions on CDI
Environmental Cleaning Daily, routine, and terminal cleaning with 1:100 bleach
Hand Hygiene Chlorhexidine gluconate before and after patient care, individual rolls of paper towels
Isolation and/or Cohorting Not specified
Lai Contact Precautions Universal precautions
Education- Staff Intense education on modes of transmission, prevention, and control
Environmental Cleaning New commode cleaning, new commodes
Hand Hygiene Emphasized for staff, new soap dispensers in patient bathrooms, towelettes before meals
Isolation and/or Cohorting CDI patients cohorted
Marufu Antibiotic Stewardship Microbiologist-led antibiotic rounds, restrictive antibiotic policy, audits
Dedicated Equipment Disposable bedpans and macerators
Education- Staff Infection control training consults, ongoing notices for staff
Environmental Cleaning Clean equipment and environment with hypochlorite, new cleaning strategy group
Hand Hygiene WHO Clean your hands campaign
Isolation and/or Cohorting Isolation unit introduced
Systems and Workflow Infection control scorecard, new infection control strategy team, review meetings, CDI feedback to all wards, Saving Lives toolkit, United Kingdom infection control code, diarrhea care plan and action cards, CDI ward rounds
Mattner Education- Staff Occupational groups trained
Environmental Cleaning Sporicidal disinfection done more frequently
Hand Hygiene Recommend gloves, hand wash, disinfection
Isolation and/or Cohorting Introduced
Mermel Antibiotic Stewardship Audit antibiotic use, provide feedback, use electronic drug orders, pre-authorization requirements, streamline therapy based on labs, optimize doses, intravenous to oral conversion, increase narrow spectrum antibiotic use, limit quinolones, clindamycin
Contact Precautions Easily accessible, many size gloves, gowns, masks in isolation rooms, empty trash often
Dedicated Equipment Blood pressure cuff, thermometer, stethoscope in isolation rooms
Education- Staff Annual infection control education, include antibiotic policy
Environmental Cleaning Hire more housekeepers, hypochlorite-based cleaning of isolation rooms, dedicate team monitor cleaning supplies, enhanced daily room cleaning
Hand Hygiene Soap and water use encouraged
Systems and Workflow New tool to identify high-risk patients, nurses order CDI test and initiate isolation, improve CDI test sensitivity, increase testing frequency, develop management guidelines
Muto Antibiotic Stewardship Clindamycin, ceftriaxone, levofloxacin, broad spectrum antimicrobials require approval
Contact Precautions Sustained for duration of hospitalization
Education- Staff Printed material, lecture at staff meetings on epidemiology, risk factors, clinical findings, control measures, and rates
Environmental Cleaning Daily cleaning with bleach (1:100) of high-touch surfaces, later increased to 1:10
Hand Hygiene Soap and water (not alcohol) for CDI patients
Isolation and/or Cohorting Cohorting facilitated by EMR
Systems and Workflow Nurses can order lab test, EMR flag high-risk patients and email alert physicians, establish CDI management team for rapid evaluation, real-time lab notifications
Olestro Antibiotic Stewardship Limit quinolones and 3rd generation cephalosporins by time and indication
Contact Precautions Gloves and aprons
Education- Staff Educate on treatment, prevention, diagnosis
Education- Patients Distribute written material
Environmental Cleaning Clean ward and equipment every 8-hours with 5,000 parts per million hypochlorite, with peroxide hydrogen vaporization after discharge
Hand Hygiene Soap and Water
Isolation and/or Cohorting Admit to individual room, cohort cases
Proton Pump Inhibitor Stewardship Limited to those clinically indicated
Systems and Workflow Report outbreak to authorities, nurses, ward leaders, establish Regional Infection Control Group network, protocol for early diagnosis and treatment, type toxin positive samples
Power Antibiotic Stewardship Antimicrobial management team developed new guidelines to restrict certain antibiotics
Education- Staff Focused and systematic education for all staff, target knowledge gaps identified by questionnaire.
Education- Patients Symptom reporting, poster campaign
Environmental Cleaning Clean seals used for equipment, disposable washbowls, bed linens stored centrally, identify key surfaces
Hand Hygiene Practices studied and improved, common errors identified, strict enforcement, hand washing rounds for patient initiated
Isolation and/or Cohorting Isolated at start of suspected symptoms
Price Antibiotic Stewardship Cephalosporin and quinolone restrictions
Contact Precautions Scrubs, gloves, and aprons changed between patient contacts
Isolation and/or Cohorting Phase 1: All diarrheal patients isolated in side rooms, Phase 2: CDI patients in CDI cohort ward within 24 hours of CDI diagnosis, kept until discharge. Dedicated nursing staff.
Salgado Contact Precautions Keep until CDI ruled out as cause of diarrhea, CDI patients kept in contact precaution for duration of hospitalization: gown, gloves, private rooms
Environmental Cleaning Use bleach in areas occupied by CDI patients
Hand Hygiene Require soap and water, not alcohol gel
Stone Antibiotic Stewardship Limit antibiotics to seven day course, restrict the use of cephalosporins
Hand Hygiene Emphasized between patients, 4% chlorhexidine scrub if prolonged contact, 0.5% chlorhexidine rub otherwise, dispensers at each bay and side room
Systems and Workflow Providers alerted to new cases, quarterly rates discussed at teaching sessions, nurses informed
Struelens Antibiotic Stewardship Alternatives to clindamycin
Contact Precautions Gloves and gowns for fecal contact
Environmental Cleaning Daily furniture and floor cleaning (0.04% formaldehyde, 0.03% glutaraldehyde), dedicated utensils, single use towels
Hand Hygiene Soap and water between patient contact
Isolation and/or Cohorting Single rooms for those with diarrhea, cohorting of infected patients
Systems and Workflow Early diagnostic testing
Suzuki Antibiotic Stewardship Carbapenem use restricted
Contact Precautions In place beginning with diarrhea
Systems and Workflow Previous microbiology results of all admissions chart reviewed by infection preventionists, MDRO information provided to ward staff, infection control rounds within two days of new MDRO or hospital admission of patient with previous MDRO infection or colonization
Valiquette Antibiotic Stewardship Decrease use of second and third generation cephalosporin, ciprofloxin, clindamycin, and macrolides, decreased course of treatment
Dedicated Equipment Rectal thermometers
Education- Staff Lectures on isolation, disinfection, cleaning, antibiotic guidelines
Environmental Cleaning Hypochlorite sodium for terminal disinfection, comprehensive ward sodium hypochlorite disinfection for wards with less than three cases
Isolation and/or Cohorting Isolate suspected cases until discharge
Weiss Antibiotic Stewardship Change antibiotic use according to Quebec guidelines
Contact Precautions Contact isolation for test-positive patients, routine gloving in CDI wards
Education- Patient CDI hand hygiene handout
Education- Staff Sixty-minute lecture on CDI transmission, epidemiology, hand hygiene, and isolation. Regular education on wards with more than two cases
Environmental Cleaning 1:50 bleach/water solution used for cleaning (down from 1:10)
Hand Hygiene Soap and water encouraged over alcohol gel before/after visit patient room, 85 new sinks
Isolation and/or Cohorting Dedicated CDI ward
Systems and Workflow Low turnover, dedicated CDI ward housekeeping team trained, rapid enzyme immunoassay diagnostic test on first liquid stool, hire four infection preventionists
Whitaker Antibiotic Stewardship Formulary restriction for high-risk antibiotics
Contact Precautions Gowns, gloves, soap and water hand hygiene only until ruled CDI negative
Education- Patient Flyer on CDI and prevention
Education- Staff Information on antibiotic use, clinical signs, prescriptive patterns, and awareness
Environmental Cleaning 10% hypochlorite disinfection in patient rooms, nursing units, horizontal surfaces, and medical equipment
Hand Hygiene Soap and water
Isolation and/or Cohorting Not specified
Systems and Workflow Automated report of MDR organism history at admission, standardized nursing units for isolation, lab results shared immediately,
White Antibiotic Stewardship Five-day duration policy for the treatment of most common infections, limitation on the use of common classes of broad spectrum agents, “Prescription codes” to sanction the use of restricted antibiotics
Education- Staff Mandatory training program for clinical staff- an online or face-to-face module on infection prevention matters, a module on antimicrobial prescribing for all medical staff and nurse prescribers
Environmental Cleaning Additional housekeeping staff, individual wards were vacated and deep cleaned before being treated with aerosolised hydrogen peroxide
Hand Hygiene Colorful signs throughout the hospital, computer screensavers, audio messages, “naked from the elbow down” policy, prohibition of white coats, and wrist and hand jewelry.
Isolation and/or Cohorting A 22-bed combined isolation and cohort ward, with six single rooms, and the remainder arranged in four bedded bays, patient cohorting
Proton Pump Inhibitor Stewardship Limited the use of proton pump inhibitors within the hospital and mandated regular review of prescriptions
Systems and Workflow “Paper care pathway,” new Infection Control Operational Group, individual Directorate Infection Control Groups, and a dedicated infection prevention nurse post in CDI
Wong-McClure Antibiotic Stewardship Broad spectrum antibiotics restricted
Contact Precautions Enforced for suspected cases, single use personal protective equipment
Environmental Cleaning Clean affected wards with 1:10 hypochlorite solution, clean equipment with 1:10 quaternary ammonium.
Hand Hygiene Enforcement campaign for staff and patients
Isolation and/or Cohorting Strict isolation for confirmed cases
You Contact Precautions Gloves and gowns
Education- Staff Lecture for all medical staff on baseline data
Environmental Cleaning Twice daily disinfection with 1000ppm sodium hypochlorite
Hand Hygiene 0.3% triclosan soap and water before and after contact with CDI patients
Isolation and/or Cohorting CDI patients in isolation zone, 2.2 meters between beds and sink, isolation until 48 hours symptom free
Zafar Contact Precautions Gloves and gowns required in CDI rooms
Dedicated Equipment Equipment dedicated to individual patients and gas sterilized
Education- Staff Monthly lecture program, videos, handouts, posters
Environmental Cleaning Phenol-containing disinfectant for surfaces contaminated with body fluids, cart wash sterilizer installed on wheelchairs, stretchers
Hand Hygiene 0.03% Triclosan soap and water required, education
Isolation and/or Cohorting Cohort patients and nurses, restrict patient movement
Systems and Workflow Centralize processing department, infection preventionist on rounds, regular meetings between infection preventionists and nurses, CDI rates disseminated monthly

CDI: Clostridium difficile infection, MDRO: multi-drug resistant organism