Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship

The Evaluation and Research on Antimicrobial Stewardship's Effect on Clostridium difficile (ERASE C. difficile) Project

Clostridium difficile infection (C. difficile) is a serious public health problem that has recently increased in both incidence and severity. Taking steps to reduce C. difficile is a major health and public health imperative. Antimicrobial stewardship targeted to C. difficile reduction shows promise, because increased rates of C. difficile are associated with inappropriate antibiotic use. An antimicrobial stewardship program (ASP) is a systematic approach to developing coordinated interventions to reduce overuse and inappropriate selection of antibiotics, and to achieve optimal outcomes for patients in cost-efficient ways. This toolkit assists hospital staff and leadership in developing an effective ASP with the potential to reduce C. difficile.

Prepared by:

Boston University School of Public Health
Montefiore Medical Center
Greater New York Hospital Association/United Hospital Fund 


Questions To Consider in Developing an Antimicrobial Stewardship Program To Reduce C. Difficile Infection
   1. Is our organization ready for an ASP to reduce C. difficile?
   2. How do we determine which interventions for reducing C. difficile to implement?
   3. How do we monitor the intervention and measure outcomes?
   4. How do we sustain the ASP for reducing C. difficile over time?
Tools and Resources


Boston University School of Public Health (BUSPH)
Carol VanDeusen Lukas, Ed.D., BUSPH and Center for Organization, Leadership, and Management Research, Department of Veterans Affairs
Elisa Koppelman, M.S.W., BUSPH and Center for Health Quality, Outcomes, and Economic Research, Department of Veterans Affairs

Montefiore Medical Center
Brian Currie, M.D., M.P.H., Vice President and Medical Director for Research
Belinda Ostrowsky, M.D., M.P.H., Director of Antimicrobial Stewardship Program
Shakara Brown, M.P.H., Data Analyst, Antimicrobial Stewardship Program
Paul Meissner, M.S.P.H., Director, Research Program Development, Office of the Medical Director for Research
Yi Guo, Pharm.D., Antimicrobial Stewardship Program
Philip Chung, Pharm.D., Antimicrobial Stewardship Program
Claire Brown, M.D., Former Infectious Diseases Fellow

Greater New York Hospital Association (GNYHA)/United Hospital Fund (UHF)
Zeynep Sumer, M.S., Vice President of Regulatory and Professional Affairs, GNYHA
Cynthia Araujo, Project Manager, GNYHA
Rafael E. Ruiz, Ph.D., Director, Outcomes Research, GNYHA
Hillary S. Jalon, M.S., Director, Quality Improvement, UHF

Agency for Healthcare Research and Quality Contributors
Katherine Crosson, M.P.H., Center for Quality Improvement and Patient Safety (retired)
James I. Cleeman, M.D., Center for Quality Improvement and Patient Safety
Darryl T. Gray, M.D., Sc.D., FAHA, Center for Quality Improvement and Patient Safety

Centers for Disease Control and Prevention
Carolyn Gould, M.D., M.S.C.R., Division of Healthcare Quality Promotion

This project was funded under Contract Number HHSA290200600012i, TO #10, from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or the U.S. Department of Health and Human Services. 


The development of this toolkit was facilitated by the participation and assistance of antimicrobial stewardship teams at 10 medical centers: Beth Israel Medical Center—Beth Israel Brooklyn (formerly known as the King's Highway Division) and The Milton and Carroll Petrie Division; Bronx-Lebanon Hospital Center; Montefiore Medical Center—The North Division, The Henry and Lucy Moses Division, and The Jack D. Weiler Hospital of the Albert Einstein College of Medicine; North Shore-Long Island Jewish Health System—Glen Cove Hospital and Southside Hospital; St. Luke's-Roosevelt Hospital Center—St. Luke's Hospital and Roosevelt Hospital.

This document is in the public domain and may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders.

Page last reviewed November 2014
Page originally created September 2012
Internet Citation: Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship. Content last reviewed November 2014. Agency for Healthcare Research and Quality, Rockville, MD.
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