Title : Improving Clostridioides difficile recognition and management through a trust-wide multimodal educational quality improvement programme
Abstract:
Background and context: Clostridioides difficile infection (CDI) remains an important healthcare-associated infection associated with substantial morbidity, prolonged hospitalisation and infection prevention challenges. Effective management requires timely recognition, appropriate diagnostic testing and treatment, antimicrobial stewardship, and rigorous infection prevention measures. However, variation in clinicians' knowledge may contribute to inconsistent practice. A Trust-wide educational needs assessment identified important knowledge gaps among doctors across multiple aspects of CDI diagnosis, interpretation of laboratory results, treatment, antimicrobial stewardship and infection prevention. A multidisciplinary quality improvement programme was therefore developed to address these gaps through an accessible and sustainable educational strategy.
Aims and objectives: To design, implement and evaluate a Trust-wide multimodal educational programme to improve doctors' knowledge of CDI recognition, diagnosis, evidence-based management, antimicrobial stewardship and infection prevention, while developing a sustainable model capable of wider implementation.
Methods: A multidisciplinary educational quality improvement programme was developed using a Plan-Do-Study-Act (PDSA) approach. Interventions were designed to provide repeated exposure through complementary educational formats and included Medical Grand Rounds, Foundation Programme and departmental teaching; an A3 CDI Quick Reference Poster displayed across inpatient wards and incorporated into the Trust MicroGuide; Trust-wide email dissemination; and a six-week digital screensaver campaign.
Knowledge was evaluated using structured electronic questionnaires completed by 100 doctors before and 100 doctors following implementation. Ten domains covering CDI recognition, investigation, treatment, antimicrobial stewardship and infection prevention were assessed. Pre- and post-intervention responses were compared using Pearson's chi-square test.
Results: Knowledge improved significantly in 9 of 10 assessed domains (all p<0.001). Correct responses increased for appropriate repeat testing (26% to 77%), CDI clinical review target (52% to 76%), first-dose treatment target (10% to 76%), antimicrobial stewardship (26% to 78%), appropriate hand hygiene (43% to 80%), recurrent CDI management (37% to 77%), interpretation of CDPCR-positive/CDT-negative results (42% to 76%), recognition of active CDI (29% to 77%), and identification of risk factors with appropriate isolation precautions (23% to 78%). Knowledge regarding stool sampling was already optimal and remained unchanged at 100%.
The intervention therefore produced broad improvement across diagnostic, therapeutic, antimicrobial stewardship and infection prevention domains, with particularly marked gains in areas where baseline knowledge was lowest.
Conclusion and future directions: A multimodal Trust-wide educational quality improvement programme was associated with substantial and statistically significant improvements in doctors' knowledge across key aspects of CDI recognition and management. Integration of educational resources into routine teaching, ward environments and digital clinical resources provides a practical framework for continued reinforcement and sustainability. The model has subsequently been adopted across multiple NHS Trusts, demonstrating its transferability beyond the original organisation. Future evaluation will assess longer-term knowledge retention and translation into clinical practice, including antimicrobial stewardship and hospital-onset CDI outcomes. The approach may provide a reproducible framework for wider national and international infection prevention education.
