Molly Bisciglia, MLS (ASCP)CM 
Dan Cates, MPH, CIC 
Annette Lund, RN, BSN, CIC 
Cindy Montgomery 
Boyd Wilson, MT (ASCP), MS, CIC, FAPIC 
Brie Zurn, RN, BSN 

Regions Hospital 
Saint Paul, MN 

Changing Culture Through Multidisciplinary Engagement 

The Regions Hospital infection prevention team created an integrated, multidisciplinary program to improve infection prevention practice across their facility. These improvements generated sustained infection reductions, as well as system-wide cultural change. 

As part of a broad Regions Hospital improvement effort kicked off in 2015, the six-person infection prevention team at this large, safety-net facility launched a comprehensive program to reduce healthcare-associated C. difficile (C.diff) infection rates.  

“We knew we wanted a multidisciplinary team to represent the work,” Boyd Wilson, Director of Infection Prevention and Control, said. “It ensured a well-rounded approach informed by the necessary expertise.” 

Following a gap analysis and literature and guidelines review, the C. diff prevention team decided to focus their efforts on environmental cleaning and disinfection, as well as determining when C. diff testing is appropriate. The hospital’s Environmental Services (EVS) director was appointed as the project’s process owner. “This was a unique approach that helped create a different level of engagement and accountability,” Wilson said.  

Over the next 33 months, the team systematically implemented tactics to reduce environmental C. diff exposure, including nurse and provider education; EVS staff education and training in the hospital simulation lab; a patient safety risk dashboard; and a regular report for nurse managers.  

On the testing front, the team revised protocols, initiated ongoing staff education, and adjusted nursing workflow, including the introduction of a two-nurse review process for specimen collection. Information technology (IT) staff modified the hospital’s electronic health records (EHR) system to support appropriate test ordering.  

The team reviewed compliance and process improvement at weekly meetings, guided partly by multidisciplinary case reviews.  

From 2015 through 2018, healthcare-associated C. diff infection rates declined 46 percent, and unnecessary or inappropriate testing declined 53 percent. 

“We’ve improved the quality and safety of our care and created a sustainable support system for staff to follow best practices,” Wilson said.