The SPARC team’s Clostridioides difficile (C. difficile) initiative focused on reducing C. difficile incidence rates in Maryland hospitals. This initiative was comprised of a literature review to understand the structure and frameworks of other successful hospital-acquired infection collaboratives, administering facility assessment tools to identify gaps in infection prevention, accessing infection prevention resources to address those gaps, and tailoring interventions to address facility-specific gaps.

Reports & Publications

Impact of Statewide Prevention and Reduction of Clostridioides difficile (SPARC), a Maryland public health–academic collaborative: an evaluation of a quality improvement intervention (BMJ Quality & Safety): This publication describes key findings from SPARC’s prior work focused on the prevention and reduction of Clostridioides difficile infections (CDIs) in Maryland hospitals. An evaluation of the efforts found that the collaborative was extremely successful—CDIs were reduced by 45% and the Maryland Standardized Infection Ratio decreased from 0.92 to 0.61.


A one page algorithm that helps providers determine whether patients with symptoms of C. difficile (primarily diarrhea) require C. difficile testing and/or isolation based on factors including laxative use and prior C. difficile testing.

The negative binomial regression model that NHSN uses to calculate the "predicted" number of infections for the C. difficile. LabID events CAD and SIR calculations are included on page 8 of this guide.

A concise guide for reducing unnecessary C. difficile testing and the potential benefits of reducing over-testing. The guide states that it is NOT appropriate to test to test patients for C. difficile in the following situations: a) patient had < 3 unformed stools in the past day, b) patient received laxatives in the past 48 hours, c) retesting C. difficle positive patients within 7 days, and d) testing C. difficile positive patients to confirm they are cured.

This is a concise instruction guide for using pH pens to determine if the correct disinfectant was used when cleaning a C. difficile room. The guide provides general instructions as well as more detailed steps, and it also includes a color chart for interpreting the markings left by a pH pen.

Webinar Recordings

Webinar Slides

Webinar Recording

(March 5, 2019) This webinar introduced viewers to the Maryland Statewide Prevention and Reduction of C. difficile (SPARC) Collaborative and reviewed the processes the Collaborative is using to reduce the number of C. difficile infections in Maryland.

Webinar Slides

(March 13, 2019) In this webinar, Emily Heil, PharmD, BCIDP, defined the special link between fluoroquinolones and C. difficile infection. The webinar focused on strategies to decrease unnecessary use of fluoroquinolones as an antimicrobial stewardship initiative to decrease C. difficile rates at your institution. It also proposed beta-lactam allergy management as a strategy for fluoroquinolone reduction and introduced options ranging from improved history taking to penicillin skin testing, that could be implemented locally at your institutions.

Webinar Slides

Webinar Recording

(June 12, 2019) In this presentation, Dr. Stuart M. Levine, MD, FACP, discussed the important role that senior level and executive leadership plays in helping drive C. difficile rate reduction, as well as how to engage in these efforts. The importance of executive leadership involvement in spurring institutional change was discussed.