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Background An automated protocol was designed within our electronic medical record (EMR) to help curb the Clostridium difficile problem at our institution. The protocol will identify patients at high risk for C difficile , improve the timing of testing of patients infected on admission, and enhance the appropriateness of C difficile testing throughout the patient's hospitalization. Methods Admitted patients with 2 of the following 3 criteria were labeled as high risk for C difficile : admission to a medical institution in the preceding 90 days, administration of antibiotics in the preceding 90 days, or a history of C difficile. High-risk patients with diarrhea in the first 3 days of admission are identified in the EMR, and prompt testing for C difficile is done. After day 3, if diarrhea develops, a series of questions is presented to help test the appropriate patients for C difficile. Results A statistically significant reduction in rates of hospital-onset C difficile was achieved after implementation of the protocol. Conclusions Implementation of an automated protocol for targeted testing of high-risk patients for C difficile was successful at reducing rates of hospital-onset C difficile by improving timing and appropriateness of testing. [ABSTRACT FROM AUTHOR]

Background Health care–associated infections are serious complications impacting 2 million patients and accounting for approximately 100,000 deaths per year. In the present study, we evaluated the effectiveness of a new hand hygiene monitoring program (HHMP) and measured the sustainability of this effectiveness over a 1-year period. Methods The HHMP consisted of 4 key components: extensive education, conspicuous and visible monitors, immediate feedback concerning compliance to health care workers, and real-time data dissemination to leadership. The HHMP was implemented in 2 hospital care units. Two different, but similar, departments served as controls, and hand hygiene compliance was monitored via the “secret shopper” technique. All 4 departments were followed for 12 months. Results Both experimental departments showed statistically significant increases in hand hygiene compliance. Experimental department 1 increased compliance from 49% to an average of 90%, and experimental department 2 increased compliance from 60% to an average of 96%. Both experimental departments were able to sustain these results for at least 6 months. Compliance rates were significantly higher in the experimental departments compared with the control departments. No significant changes were seen in the control departments. Conclusions These finding suggest that continuous monitoring by salient observers and immediate feedback are critical to the success of hand hygiene programs. [ABSTRACT FROM AUTHOR]