Table 3.

Perspectives on the SPARC collaborative from interviews with eight SPARC intervention hospitals

Interviewees’ perspectives	Quote
SPARC provided
…access to external subject matter experts that lent credibility to and validated existing efforts, and increased awareness around reduction in Clostridioides difficile infection. Subject matter experts and webinars provided synthesised information on best practices, particularly for hospitals without in-house capacity.	‘The respect of [Johns Hopkins University, University of Maryland, Baltimore], the state health department… we’re pulling evidence-based recommendations from other people, it wasn’t just something we were doing to make our numbers look right.’ (Infection control interviewee)
…an organising structure for multidisciplinary collaboration. Cross-departmental collaboration improved engagement of staff beyond infection control.	‘[SPARC] involved many people and departments: eg, lab, environmental cleaning, nursing. It wasn’t just Infection Control… this became everybody’s problem.’ (Infection control director)
…opportunities for peer-to-peer exchange across hospitals. Participants were satisfied with in-person meetings, particularly for connecting with other hospitals. Providing an in-person meeting for peer-to-peer exchange was a result of feedback from the first round of interviews, where hospitals expressed an interest in more peer-to-peer exchange opportunities.	‘I think the SPARC-le day* was excellent; super helpful. It was… really great to have such a strong [environmental cleaning] team do the fluorescent gel demonstration.’ (Infection control director)
…a structure for tracking progress and accountability. Development of intervention implementation plans and monthly and ad hoc calls helped hospitals stay on track.	‘[SPARC]… keeps us in line to focus on these interventions as a team. Now that we’re putting it down on paper, in black and white, it holds us accountable.’ (Infection control director)
…preintervention site visits, which renewed momentum for C. difficile reduction and highlighted unknown issues. Assessments highlighted potential areas for improvements. Additional in-person site visits would have enhanced staff engagement and help assess changes.	‘We thought our staff and providers were doing a good job… when [SPARC] did observations on the unit, we found that we did have a little bit of a problem.’ (Nurse)
Other SPARC resources (ie, webinars, trainings, tools) had mixed utility and limited reach. Webinars were valuable for learning new information, though attending webinars was difficult and hospitals had expressed interest in more peer-to-peer exchange opportunities. Awareness of the SPARC website and resources was low.	‘The webinars were a helpful reinforcement tool for frontline staff who participate.’ (Infection control director)
Once positive gains were achieved, engagement in SPARC decreased. Attention shifted once C. difficile was ‘under control’. Need for additional flexibility (ie, no longer attending monthly calls, less frequent updates to intervention implementation plans) to maintain engagement.	‘I don't have time to do this anymore. Big things† have come along and that’s what my focus is going to be.’ (Infection control interviewee)

*SPARC-le was an in-person event focused on sharing best practices, challenges and lessons learnt in infection prevention and environmental cleaning to prevent C. difficile.

†Follow-up interviews coincided with the beginning of the COVID-19 pandemic, to which the respondent was referring.

SPARC, Statewide Prevention and Reduction of C. difficile.