Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship

Section	Question Addressed	Resources and Tools
*1. Is our organization ready for an ASP to reduce C. difficile?*	1.1. Do we have the appropriate ASP foundation on which to build?	Ø 1A RESOURCE: SHEA/IDSA/PIDS Policy Statement. Policy Statement on Antimicrobial Stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) Ø 1B RESOURCE: GNYHA/UHFAntimicrobial Stewardship Toolkit (PDF File; Plugin Software Help) Ø 1C RESOURCE: Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program To Enhance Antimicrobial Stewardship (PDF File; Plugin Software Help) Ø 1D RESOURCE: Examples of State and Local Stewardship Programs Ø 1E TOOL: Assessment of Current ASP Elements Ø 1F TOOL: Common Evidence-Based Infection Prevention Measures
	1.2. What do we need to do before we begin to use our ASP to target C. difficile?	Ø 1G TOOL: Assessing Leadership Support Ø 1H TOOL: Stakeholder Analysis Ø 1I TOOL: Survey of Staff Attitudes Toward ASP and Current Practices Ø 1J RESOURCE: Antimicrobial Stewardship: Implementation Tools & Resources: Other Resources Ø 1K TOOL: Developing Business Case Ø 1L TOOL: Assessing Resource Needs Ø 1M TOOL: Potential Barriers to Implementing an ASP
*2. How do we determine which interventions for reducing C. difficile* to implement?**	2.1. What is the institutional risk assessment approach and how can it help us?	Ø 2A RESOURCE: Institutional Risk Assessment Approach to Selecting Stewardship Interventions Ø 2B RESOURCE: A Comparison of Antibiotic Data Sources Ø 2C RESOURCE: Possible Methods for Evaluating Antibiotic Use
	2.2. How do we conduct a time-limited internal case-control study for C. difficile? What are some of the challenges?	Ø 2D RESOURCE: Does Choice of Control Group Affect the Association of Antibiotics With Clostridium difficile-Associated Diarrhea? Ø 2E RESOURCE: Sample Tracking and Summary Forms for Case-Control Study (can be used to organize your case-control comparisons and summarize results and potential antibiotic targets)
	2.3. What methods can we use to review the use of potential target antibiotics for intervention activities?	Ø 2A RESOURCE: Institutional Risk Assessment Approach to Selecting Stewardship Interventions
	2.4. What factors do we need to consider in choosing interventions?	Ø 2F RESOURCE: A Comparison of Potential Antimicrobial Stewardship Interventions Ø 2G RESOURCE: A Review of Antimicrobial Stewardship Interventions With Suggested Process/Monitoring, Antibiotic Use, and Additional Measures of Impact Ø 2H RESOURCE: Specific Intervention Examples From ERASE C. difficile Project
3. How do we monitor the intervention and measure outcomes?	3.1. How do we measure rates of C. difficile over time?	Ø 3A RESOURCE: Hospital-Acquired Infection (HAI) Rates in New York State Hospitals Ø 3B RESOURCE: About NHSN Ø 3C RESOURCE: NHSN Manuals and Protocols Ø 3D RESOURCE: NHSN Patient Safety Component, MDRO/CDI Module (customizable reporting forms, including Laboratory-Identified MDRO or CDI Event [PDF File; Plugin Software Help]) Ø 3E RESOURCE: Instructions for Completion of the Laboratory-Identified MDRO or CDI Event Form (PDF File; Plugin Software Help)
	3.2. How do we obtain, measure, and analyze antibiotic data?	Ø 2C RESOURCE: Possible Methods for Evaluating Antibiotic Use Ø 2G RESOURCE: A Review of Antimicrobial Stewardship Interventions With Suggested Process/Monitoring, Antibiotic Use, and Additional Measures of Impact Ø 3F RESOURCE: World Health Organization Defined Daily Dose Definition and General Considerations (links on left side of page go to DDD lists)
	3.3. How can we monitor the intervention and why should we?	Ø 2G RESOURCE: A Review of Antimicrobial Stewardship Interventions With Suggested Process/Monitoring, Antibiotic Use, and Additional Measures of Impact
	3.4. What are other processes we need to monitor and measure?	Ø 1I TOOL: Survey of Staff Attitudes Toward ASP and Current Practices Ø 3G/3H RESOURCE: Environmental Cleaning and Infection Prevention Checklists
	3.6. How do we assess the overall impact of our interventions? How do we decide which interventions have been the most successful (and which interventions were not) and why?	Ø 2H RESOURCE: Specific Intervention Examples From ERASE C. difficile Project
*4. How do we sustain the ASP for reducing C. difficile* over time?**		Ø 4A TOOL: How Do We Sustain ASP for Reducing C. difficile Over Time?
Resources Developed and Used by Participating Facilities		Ø 4B TOOL: UTI Guidelines Form Ø 4C TOOL: Piperacillin/Tazobactam De-Escalation Form Ø 4D TOOL: Medication Use Evaluation Template

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Current as of September 2012

Internet Citation: Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship. September 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/cdifftoolkit/cdiffl2tools.html