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