{"doi":"10.1017/ice.2020.525","title":"Mitigating Hospital-Onset <i>Clostridioides difficile</i>: Evaluation of a Standardized Environmental Hygiene Program in Eight Hospitals","abstract":"Background: Despite ongoing efforts over the past 3 decades, hospital-onset Clostridioides difficile infection (HO-CDI) continues to challenge interventions aimed at its prevention and control. We describe the impact of a model environmental services (EVS) program on the incidence of HO-CDI across 8 hospitals that are part of a nationwide integrated health system. Methods: Eight acute-care hospitals with 44–532 beds (mean, 263 beds) in 6 states with stable endemic HO-CDI incidence densities independently implemented identical sporicidal environmental hygiene interventions in 2017. The program combined the use of a hydrogen peroxide/peroxyacetic acid surface disinfectant for all patient-zone hygienic cleaning combined with a structured model EVS cleaning program that included optimized cleaning and disinfection technique, staff training, and auditing with objective performance feedback, which aligned with 2008 HICPAC/CDC categories I and II as well as 2010 CDC Guidance Level II monitoring program recommendations. After a 3-month phase-in, we compared NHSN-reported LabID HO-CDI SIRs for 18 months before and 12 months after implementation of the program. Results were not shared between sites and data were not collated by the authors until a year after the postintervention results were initially available. Multiple possible confounding factors were evaluated and determined not to have identifiably affected the outcome. Results: Mean preintervention HO-CDI SIRs over the 18 months measured ranged from 0.5 to 1.4 (mean, 1.0 for the group). Following the wash-in period, SIRs decreased precipitously in all sites to a mean of 0.42 for the group by the end of 12 months of the intervention. ( P &lt; .0001) (Fig. 1). Individual site improvement ranged from 20% to 92% (mean, 57%) (Fig. 2.) Conclusions: Overall, HO-CDI SIRs decreased almost 60% in the study hospitals following daily sporicidal disinfection cleaning of all patient-zone surfaces in association with ongoing programmatic optimization of cleaning practice. As predicted by earlier single-site studies reporting a favorable impact of sporicidal disinfectant cleaning in outbreak settings, this multisite quasi-experimental study has illustrated the substantial potential impact of hospital-wide sporicidal disinfection integrated with objectively sustained optimized thoroughness of cleaning to decrease the incidence of HO-CDI. Funding: None Disclosures: None","journal":"Infection Control and Hospital Epidemiology","year":2020,"id":127576,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9199,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":338322,"name":"Lyndsay M. O’Hara","orcid":null,"position":1,"is_corresponding":false},{"id":285568,"name":"Anthony D. Harris","orcid":"0000-0003-2193-1560","position":2,"is_corresponding":false},{"id":577866,"name":"Russell N. Olmsted","orcid":null,"position":3,"is_corresponding":false},{"id":577865,"name":"Philip Carling","orcid":null,"position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-18T23:15:34.966380Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}