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Prevention of Hospital-Onset Clostridium difficile Infection in the New York Metropolitan Region Using a Collaborative Intervention Model


  • Brian S. Koll,

  • Rafael E. Ruiz,

    Corresponding author
    • For more information on this article, contact Rafael E. Ruiz at

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  • David P. Calfee,

  • Hillary S. Jalon,

  • Rachel L. Stricof,

  • Audrey Adams,

  • Barbara A. Smith,

  • Gina Shin,

  • Kathleen Gase,

  • Maria K. Woods,

  • Ismail Sirtalan


The incidence, severity, and associated costs of Clostridium difficile (C. difficile) infection (CDI) have dramatically increased in hospitals over the past decade, indicating an urgent need for strategies to prevent transmission of C. difficile. This article describes a multifaceted collaborative approach to reduce hospital-onset CDI rates in 35 acute care hospitals in the New York metropolitan region. Hospitals participated in a comprehensive CDI reduction intervention and formed interdisciplinary teams to coordinate their efforts. Standardized clinical infection prevention and environmental cleaning protocols were implemented and monitored using checklists. Monthly data reports were provided to hospitals for facility-specific performance evaluation and comparison to aggregate data from all participants. Hospitals also participated in monthly teleconferences to review data and highlight successes, challenges, and strategies to reduce CDI. Incidence of hospital-onset CDI per 10,000 patient days was the primary outcome measure. Additionally, the incidence of nonhospital-associated, community-onset, hospital-associated, and recurrent CDIs were measured. The use of a collaborative model to implement a multifaceted infection prevention strategy was temporally associated with a significant reduction in hospital-onset CDI rates in participating New York metropolitan regional hospitals.