Navigating CDI Prevention Implementation: Frontline Insights from VA Health Care Facilities

A recent study that draws upon frontline worker perspectives found that the barriers and facilitators to the sustained implementation of the VA CDI Bundle in addressing Clostridioides difficile infections (CDI) are crucial for improving health care-associated infection prevention practices.  

The VA multidrug-resistant organism (MDRO) Program Office initiated a national CDI Prevention Initiative in 2012 to combat CDI as the leading cause of health care-associated infections. The initiative made it mandatory for inpatient facilities to adopt the VA CDI Bundle, a set of prevention practices. To analyze the long-term implementation of the bundle, they employed the systems engineering initiative for patient safety (SEIPS) framework and factored in perspectives from frontline workers. 

From October 2019 to July 2021, interviews were conducted with 29 key stakeholders including IPC leaders, nurses, physicians, and environmental management staff, at 4 participating sites. The analysis of the interviews aimed to identify the themes and perceptions regarding the facilitators and barriers of CDI prevention. 

Researchers found that IPC leadership was most likely to have a comprehensive understanding of the specific components of the VA CDI Bundle. Other participants displayed widespread knowledge of CDI prevention practices with varying levels of awareness of specific practices based on their roles. Leadership support, mandated CDI training, and easily accessible training from various sources were identified as facilitators. In contrast, communication restrictions on facility or unit-level CDI rates, unclear communication regarding CDI prevention practice updates and VA mandates, and hierarchical roles hindering team members' clinical contributions were identified as barriers. 

Recommendations include improving centrally mandated clarity about and standardization of CDI prevention policies, including testing. Also recommended were regular IPC training updates for all clinical stakeholders.  

“A work system analysis using SEIPS identified barriers and facilitators to CDI prevention practices that could be addressed both nationally at the system level and locally at the facility level, specifically in the areas of communication and coordination,” said researchers.  

Reference  

Parmasad V, Keating J, McKinley L, et al. Frontline perspectives of C. difficile infection prevention practice implementation within veterans affairs health care facilities: A qualitative study. American Journal of Infection Control. 2023; 51(10): 1124-1131. doi:10.1016/j.ajic.2023.03.014.