Date of Award




Document Type


Degree Name

Doctor of Philosophy (PhD)


Department of Public Administration and Policy

Content Description

1 online resource (ii, iv, 132 pages) : illustrations (some color)

Dissertation/Thesis Chair

Ashley Fox

Committee Members

Wendy Weller, Stephen Weinberg


Clostridium difficile, Infection prevention, patient safety, quality improvement, Nosocomial infections

Subject Categories

Public Administration | Public Health | Public Policy


Those receiving medical care are at risk for developing serious hospital-acquired conditions (HACs), which include infections (HAIs) and other harm while receiving medical care. Pay for performance programs initiated by the Centers for Medicare and Medicaid Services (CMS), and private payers, linking reimbursements to quality of care, have created financial incentives for hospitals to address these HACs. The most common HAI in the United States, causing almost half a million infections, with 29,000 deaths within 30 days of diagnosis, results from Clostridium difficile. Infection with this bacterium leads to deadly diarrhea, and disproportionately impacts patients 65 and older, representing 80% of C. difficile deaths. People contract C. difficile infection (CDI) in an acute care setting in a variety of ways: risk of CDI is 7-10 times more likely while taking antibiotics and during the month after; coming into contact with unclean surfaces contaminated with feces from an infected person; and inadequate or improper hand hygiene of healthcare workers.