Reducing Clostridioides difficile Infections in Hospitalized Older Adults

Clostridioides difficile infection (CDI) poses a considerable health threat, especially to hospitalized elderly individuals. This demographic is especially susceptible to age-related variables, such as compromised immune systems and comorbidities. The morbidity and mortality rates linked to CDIs are significantly elevated, with more than 80% of fatalities attributable to this infection occurring in those aged 65 and above (Dohrendorf et al., 2021). Addressing CDI in older persons is essential for health promotion, as it corresponds with the Healthy People 2030 effort, which seeks to diminish healthcare-associated infections and enhance health outcomes for at-risk populations. This paper will explore evidence-based health promotion practices aimed at reducing CDIs in hospitalized older adults in our communities.

Target Population

The intended demographic for this health promotion initiative comprises older persons, specifically those admitted to hospitals in Texas. The Centers for Disease Control and Prevention (CDC) reports that older persons are disproportionately impacted by CDI, with around 450,000 cases documented annually in the United States (Guh et al., 2020). Of these, over 29,000 culminate in fatalities, underscoring the critical necessity for efficacious preventative methods. The Healthy People 2030 project underscores the necessity of diminishing healthcare-associated infections, especially among older persons, to foster health equity and improve quality of life. The incidence of CDI among older adults in Texas is a significant issue, requiring the immediate need for focused health promotion intervention to reduce its negative effects on the population.

Article Summary

Recent research has yielded significant insights into ways to mitigate CDIs in older persons. The initial publication by Dohrendorf et al. (2021) examines the efficacy of several quality improvement initiatives designed to mitigate Clostridioides difficile infections in hospitalized elderly patients. The research examined data from more than 25,000 patients, demonstrating a notable decrease in CDI prevalence by introducing a comprehensive intervention comprising sporicidal cleaning, probiotics, and enhanced hygiene protocols. While individual interventions lacked significant influence, the collective strategy proved effective, indicating that increased staff knowledge and training were essential in the observed results. The research revealed risk variables like antibiotic usage and previous hospital admissions, highlighting the necessity for tailored treatments within this at-risk population.

The subsequent article by Rubak et al. (2024) examines the effects of early comprehensive geriatric assessment (CGA) on elderly patients with CDI in Denmark. The randomized experiment encompassed 217 individuals, contrasting Comprehensive Geriatric Assessment (CGA) with routine treatment. Results demonstrated that although the 90-day mortality rates were comparable between groups, the CGA group encountered fewer fatalities directly linked to CDI. This highlights the significance of customized geriatric care, which tackles illness and the weakness frequently observed in older persons. The study emphasizes the potential of CGA to increase clinical outcomes and proposes that incorporating such assessments into standard care may improve treatment efficacy for elderly patients with CDI.

The third publication by Feuerstadt et al. (2022) presents a retrospective review of mortality, healthcare utilization, and expenses related to CDI in older persons. The research indicated that recurrent CDI episodes markedly elevated mortality rates, with around 25% of patients succumbing after recurrence, in contrast to merely 2.7% following first infections. The investigation indicated that decedents experienced elevated hospitalization rates, extended lengths of stay, and significantly increased healthcare expenditures. The findings underscore the urgent necessity for efficacious prevention and treatment measures for CDI in older persons, given the significantly elevated economic burden and mortality risk within this population.

The insights from these articles will enrich the health promotion project by directing actions designed to decrease CDI incidence and enhance care for older persons, notably through thorough evaluations and focused prevention strategies. These publications emphasize the importance of executing comprehensive efforts to mitigate CDIs in hospitalized elderly patients through early diagnosis and antibiotic management (Rubak et al., 2024). By implementing infection control protocols, augmenting geriatric evaluations, and increasing knowledge of CDI concerns, healthcare practitioners can markedly enhance patient outcomes.

Health Promotion

To effectively inform the target audience about CDI and encourage lifestyle modifications, various initiatives can be utilized, including customized educational programs, integration of health promotion tactics, collaborative care methodologies, and community involvement.  Developing focused educational efforts for older individuals and their carers is imperative. These programs must emphasize the significance of hand cleanliness, prudent antibiotic utilization, and the early identification of CDI symptoms (Dohrendorf et al., 2021). Employing comprehensible booklets and engaging workshops might improve comprehension and adherence among elderly individuals. Furthermore, behavioral change frameworks, such as the Health Belief Model or the Transtheoretical Model, can inform interventions designed to mitigate CDI risks. These approaches facilitate the consideration of patients’ beliefs and their preparedness for change, promoting a culture of infection prevention.

Moreover, fostering a multidisciplinary approach that includes physicians, nurses, and pharmacists is essential for enhancing stewardship and compliance with infection control protocols. Collaborative care can improve communication and ensure all healthcare practitioners are coordinated to mitigate CDIs (Rubak et al., 2024). Ultimately, including the community through health fairs and instructional workshops can enhance knowledge of CDI and its prevention. Partnering with local organizations to furnish resources and assistance for older individuals can augment health promotion initiatives. By incorporating these strategies with a culturally attuned comprehension of older adult demographics, healthcare practitioners might improve health promotion initiatives and significantly diminish hospital CDIs. These techniques correspond with the Healthy People initiative’s goals to enhance care quality and patient safety in healthcare environments.

Conclusion

In summary, mitigating Clostridioides difficile infections in hospitalized elderly patients is an essential public health imperative. The elevated morbidity and mortality rates linked to CDI in this at-risk population require focused interventions and thorough health promotion initiatives. By implementing customized educational programs, promoting collaborative care practices, and engaging in community engagement, healthcare providers can markedly decrease the prevalence of CDI and enhance health outcomes for older persons. Resolving this issue is crucial for improving patient safety, advancing health equity, and enhancing the overall quality of life for older persons in Texas and beyond.

 

 

References

Dohrendorf, C. M., Unkel, S., Scheithauer, S., Kaase, M., Meier, V., Fenz, D., Sasse, J., Wappler, M., Schweer-Herzig, J., Friede, T., Reichard, U., Eiffert, H., Nau, R., & Seele, J. (2021). Reduced Clostridioides difficile infections in hospitalized older people through multiple quality improvement strategies. Age And Ageing, 50(6), 2123–2132. https://doi.org/10.1093/ageing/afab169

Feuerstadt, P., Nelson, W. W., Drozd, E. M., Dreyfus, J., Dahdal, D. N., Wong, A. C., Mohammadi, I., Teigland, C., & Amin, A. (2022). Mortality, Health Care Use, and Costs of Clostridioides difficile Infections in Older Adults. Journal of the American Medical Directors Association, 23(10), 1721-1728.e19. https://doi.org/10.1016/j.jamda.2022.01.075

Guh, A. Y., Mu, Y., Winston, L. G., Johnston, H., Olson, D., Farley, M. M., Wilson, L. E., Holzbauer, S. M., Phipps, E. C., Dumyati, G. K., Beldavs, Z. G., Kainer, M. A., Karlsson, M., Gerding, D. N., & McDonald, L. C. (2020). Trends in U.S. Burden of Clostridioides difficile Infection and Outcomes. New England Journal of Medicine, 382(14), 1320–1330. https://doi.org/10.1056/nejmoa1910215

Rubak, T., Baunwall, S. M. D., Gregersen, M., Paaske, S. E., Asferg, M., Barat, I., Secher-Johnsen, J., Riis, M. G., Rosenbæk, J. B., Hansen, T. K., Ørum, M., Steves, C. J., Veilbæk, H., Hvas, C. L., & Damsgaard, E. M. S. (2024). Early geriatric assessment and management in older patients with Clostridioides difficile infection in Denmark (CLODIfrail): a randomized trial. The Lancet Healthy Longevity, 100648. https://doi.org/10.1016/j.lanhl.2024.100648

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Purpose

This assignment allows the learner to apply knowledge gained about health promotion concepts and strategies, enhance written communication skills, and demonstrate a beginning understanding of cultural competency.

Course outcomes:  This assignment enables the student to meet the following course outcomes:

1. Discuss the professional nurse’s role in health promotion activities. (PO 1 and 2)
2. Discuss health promotion, illness prevention, health maintenance, health restoration, and rehabilitation in relation to the nurse’s role in working with various populations. (PO 1, 2, and 8)
3. Identify health promotion strategies throughout the life span. (PO 1, 2, and 4)

Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.

Total points possible: 100 points

Preparing the assignment

Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.

• Identify a health problem or need for health promotion for a particular stage in the life span of a population from a specific culture in your area.
• Choose one of the Leading Health Indicator (LHI) priorities from Healthy People. https://health.gov/healthypeople/objectives-and-data/leading-health-indicators
• Research a topic related to health and wellness associated with one of the Healthy People topic areas.
• Submit your topic to the instructor for approval at least 2 weeks prior to the final assignment due date, but earlier if desired. All topics must be approved.
• You will develop an educational health promotion project addressing the population/culture in your area.
• Use TurnItIn in time to make any edits that might be necessary based on the Similarity Index prior to submitting your paper to your faculty. Consult with your faculty about the acceptable Similarity Index for this paper.
• For writing assistance, visit the Writing Center page https://mychamberlain.sharepoint.com/sites/StudentResourceCenter/WC.
• Include the following sections (detailed criteria listed below and in the Grading Rubric).
  1. Introduction and Conclusion- 15 points/15%
     • Introduction establishes the purpose of the paper and describes why topic is important to health promotion in the target population in your area.
     • Introduction stimulates the reader’s interest.
     • Conclusion includes the main ideas from the body of the paper.
     • Conclusion includes the major support points from the body of the paper.
  2. Relate Topic to Target Population- 25 points/25%
     • Describes the topic and target cultural population.
     • Includes statistics to support significance of the topic.
     • Explains how the project relates to the selected Healthy People topic area.
     • Applies health promotion concepts.
  3. Summary of Articles- 25 points/25%
     • A minimum of three (3) scholarly articles, from the last 5 years, are used as sources.
     • Articles meet criteria of being from scholarly journals and include health promotion and wellness content.
     • At least one article is related to the chosen cultural group.
     • Summaries all key points and findings from the articles.
     • Includes statistics to support significance of the topic.
     • Discusses how information from the articles is used in the Health Promotion Project, including specific examples.
  4. Health Promotion Discussion – 25 points/25%
     • Describes approaches to educate the target population about the topic.
     • The approaches are appropriate for the cultural target population.
     • Identifies specific ways to promote lifestyle changes within the target population.
     • Applies health promotion strategies.
  5. APA Style and Organization – 10 points/10%
     • TurnItIn is used prior to submitting paper for grading.
     • Revisions are made based on TurnItIn originality report.
     • References are submitted with assignment.
     • Use current APA format and is free of errors.
     • Grammar and mechanics are free of errors.
     • Paper is 3-4 pages, excluding title and reference pages.
     • Information is organized around required components and flows in a logical sequence.

 

 

 

 

Grading Rubric

Criteria are met when the student’s application of knowledge within the paper demonstrates achievement of the outcomes for this assignment.

Assignment Section and Required Criteria (Points possible/% of total points available)	Highest Level of Performance	High Level of Performance	Satisfactory Level of Performance	Unsatisfactory Level of Performance	Section not present in paper
Introduction and Conclusion (15 points/15%)	15 points	13 points	12 points	8 points	0 points
Required criteria 1.    Introduction establishes the purpose of the paper and describes why topic is important to health promotion in the target population in your area. 2.    Introduction stimulates the reader’s interest. 3.    Conclusion includes the main ideas from the body of the paper. 4.    Conclusion includes the major support points from the body of the paper.	Includes no fewer than 4 requirements for section.	Includes no fewer than 3 requirements for section.	Includes no fewer than 2 requirements for section.	Includes 1 or fewer requirements for section.	No requirements for this section presented.
Relate Topic to Target Population (25 points/25%)	25 points	20 points	15 points	10 points	0 points
Required criteria 1.    Describes the topic and target cultural population. 2.    Includes statistics to support significance of the topic. 3.    Explains how the project relates to the selected Healthy People topic area. 4.    Applies health promotion concepts.	Includes no fewer than 4 requirements for section.	Includes no fewer than 3 requirements for section.	Includes no less than 2 requirements for section.	Includes 1 or fewer requirements for section.	No requirements for this section presented.
Summary of Articles (25 points/25%)	25 points	23 points	21 points	10 points	0 points
Required criteria 1.    A minimum of three (3) scholarly articles, from the last 5 years, are used as sources. 2.    Articles meet criteria of being from scholarly journals and include health promotion and wellness content. 3.    At least one article is related to the chosen cultural group. 4.    Summaries all key points and findings from the articles. 5.    Includes statistics to support significance of the topic. 6.    Discusses how information from the articles is used in the Health Promotion Project, including specific examples.	Includes no fewer than 6 requirements for section.	Includes no fewer than 5 requirements for section.	Includes no fewer than 4 requirements for section.	Includes 1-3 requirements for section.	No requirements for this section presented.
Health Promotion Discussion (25 points/25%)	25 points	23 points	21 points	10 points	0 points
Required criteria 1.    Describes approaches to educate the target population about the topic. 2.    The approaches are appropriate for the cultural target population. 3.    Identifies specific ways to promote lifestyle changes within the target population. 4.    Applies health promotion strategies.	Includes no fewer than 4 requirements for section.	Includes no fewer than 3 requirements for section.	Includes no fewer than 2 requirements for section.	Includes 1 or fewer requirement for section.	No requirements for this section presented.
APA Style and Organization (10 points/10%)	10 points	9 points	8 points	4 points	0 points
Required criteria 1.    TurnItIn is used prior to submitting paper for grading. 2.    Revisions are made based on TurnItIn originality report. 3.    References are submitted with assignment. 4.    Uses current APA format and is free of errors. 5.    Grammar and mechanics are free of errors. 6.    Paper is 3-4 pages, excluding title and reference pages. 7.    Information is organized around required components and flows in a logical sequence.	Includes no fewer than 7 requirements for section.	Includes no fewer than 6 requirements for section.	Includes no fewer than 5 requirements for section.	Includes 1-4 requirements for section.	No requirements for this section presented.
Total Points Possible = 100 points