# Mentored Enhanced Implementation and Evaluation of National VA Mandates To Prevent The Spread Of C Difficile infection

> **NIH VA I01** · WM S. MIDDLETON MEMORIAL VETERANS HOSP · 2021 · —

## Abstract

Background: C. difficile infection (CDI) is increasing in incidence and severity; CDI affects 500,000 Americans
each year, causes 20,000 deaths annually, and imposes a significant financial burden on healthcare
institutions. Preventing CDI is essential, and the VA Multidrug Resistant Organism (MDRO) Program Office
recently mandated a bundle for prevention of CDI in VA facilities. The bundle includes appropriate diagnostic
testing, optimization of hand hygiene compliance, contact isolation for CDI, and environmental cleaning of
rooms of patients with CDI. However, it does not address optimum implementation strategies to ensure
successful application of these interventions, nor does it prescribe how these measures may be undertaken.
Implementing and adhering to these recommended measures varies considerably across institutions.
Specific Aims: The central hypothesis of this project is that variation in practices and approaches related to
environmental cleaning—particularly daily cleaning—will emerge as major contributors to variable
implementation of the CDI bundle and CDI rates. The rationale stems from the literature identifying frequent
environmental contamination with C. difficile and the findings of our pilot work. Our objective is to assess work
system barriers and facilitators to bundle implementation using a mixed-methods approach. The specific aims
for this project are:
 1. To evaluate the association between existing CDI bundle implementation and CDI rates at 10 VA sites.
 2. To identify practices that facilitate or impede CDI bundle implementation at 10 VA sites.
 3. Pilot and finalize tools to improve environmental cleaning at one VA site using the rapid plan-do-study-
 act cycle methodology of quality improvement.
Methods: We will use the innovative Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model of
work system and patient safety as the study framework integrated with the iPARiHS framework. This model, as
well as general literature on guideline implementation, will guide interview questions. Participants will include
nurses, physicians, patients, environmental services and hospital leadership. We will conduct direct
observations of healthcare workers based on the SEIPS 2.0 model. We will observe patient rooms, individuals,
tasks, and organization to better understand the overall work system that surrounds the process of care for
CDI patients.
Impact: Prevention of Clostridium difficile is a priority of the VA, and implementation of a C. difficile prevention
bundle, akin to an already established methicillin-resistant Staphylococcus aureus (MRSA) bundle, has
recently been rolled out nationally. However, our ability to devise and implement strategies for containment of
C. difficile is hampered by a limited understanding of factors influencing acquisition, spread, and prevention of
C. difficile in VA facilities. Immediate benefits of achieving the objectives of this proposal will be generation of
important data regardin...

## Key facts

- **NIH application ID:** 10216348
- **Project number:** 5I01HX002332-03
- **Recipient organization:** WM S. MIDDLETON MEMORIAL VETERANS HOSP
- **Principal Investigator:** NASIA SAFDAR
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-10-01 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10216348

## Citation

> US National Institutes of Health, RePORTER application 10216348, Mentored Enhanced Implementation and Evaluation of National VA Mandates To Prevent The Spread Of C Difficile infection (5I01HX002332-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10216348. Licensed CC0.

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