(Press-News.org) Arlington, Va., May 11, 2023 – A new study published today in the American Journal of Infection Control (AJIC) suggests that allowing bedside nurses to independently order testing for C. difficile significantly decreased the amount of time to receive test results as compared to requiring physician approval. The findings suggest that the testing policy change could potentially decrease the risk of additional patient infections and the corresponding hospital economic burden.
Individuals with C. difficile infection (CDI) can be asymptomatic or have symptoms ranging from mild diarrhea to severe and life-threatening inflammation of the colon. CDI is responsible for 223,000 healthcare-associated infections (HAIs) resulting in more than 12,000 deaths and $6.3 billion in costs in the United States annually. [1],[2] Despite numerous implementation strategies to address prevention of the infection, it remains one of the most common HAIs.[3],[4] Early detection, isolation and contact precautions, environmental cleaning, and appropriate antibiotic treatment greatly decrease the rate of morbidity and mortality and can prevent further spread to other patients, decreasing the overall clinical and economic impact.
“Given the implications of CDI on both a hospital and patient level, incentives exist for improving approaches to the prevention and spread of this infection in the clinical environment,” said Ashley Bartlett, MD, Fargo VA Healthcare System, Fargo, ND, and the lead author on the published study. “Our findings suggest that allowing bedside nurses with appropriate training to order C. diff testing based on patient symptomology could be a valid strategy to help healthcare systems achieve this goal.”
At a single site within the Veterans Affairs (VA) Healthcare System in Fargo, ND, infectious disease and nursing staff developed a policy change allowing nurses to independently order stool samples for new patients displaying CDI symptoms, rather than requiring a physician’s electronic signature. Researchers then evaluated the effectiveness of the new policy by comparing the frequency of tests being ordered, the time to obtain test results, the number of positive and negative tests, and the time to initiate treatment for positive C. difficile tests for the 44 months prior to and 59 months after the change.
Results show:
After the policy change, there were a relatively even proportion of physicians and nurses ordering the stool PCR labs (51.1% vs 48.9%, respectively).
The percent of positive and negative tests results before and after the policy change was relatively unaffected (13.9% vs. 11.5% respectively), suggesting that allowing nursing staff to order stool samples does not lead to increased unnecessary laboratory resource use or financial burden to the hospital.
Following the policy change, the average difference in time to obtain the test result after the PCR lab order was statistically significant before, versus after, the policy change (mean [sd]; 2.1 (1.3) vs. 1.3 (0.7) hours; p<0.1).
The average difference in time to obtain the test result after the PCR lab order between nurses and physicians was also statistically significant after the change (mean [sd]; 1.2 (0.7) vs. 1.3 (0.7) hours; p=.02).
There was no significant difference in time to initiate treatment before and after the policy change (1.7 hours vs. 1.7 hours). The authors suggest this was because the process of notifying physicians to initiate antibiotic treatment did not change – nurses did not receive test results directly, nor could they order antibiotics.
“We need practical strategies to reduce the significant burden of C. diff infections,” said Patricia Jackson, RN, BSN, MA, CIC, FAPIC, 2023 APIC president. “This study highlights one such strategy that healthcare facilities should consider to expedite appropriate C. diff testing and speed up implementation of appropriate treatment and infection control measures.”
About APIC
Founded in 1972, the Association for Professionals in Infection Control and Epidemiology (APIC) is the leading association for infection preventionists and epidemiologists. With more than 15,000 members, APIC advances the science and practice of infection prevention and control. APIC carries out its mission through research, advocacy, and patient safety; education, credentialing, and certification; and fostering development of the infection prevention and control workforce of the future. Together with our members and partners, we are working toward a safer world through the prevention of infection. Join us and learn more at apic.org.
About AJIC
As the official peer-reviewed journal of APIC, The American Journal of Infection Control (AJIC) is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. Published by Elsevier, AJIC also publishes infection control guidelines from APIC and the CDC. AJIC is included in Index Medicus and CINAHL. Visit AJIC at ajicjournal.org.
NOTE FOR EDITORS
“Does clinician-initiated Clostridioides difficile testing improve outcomes of patients with Clostridioides Difficile infection?” by Ashley Bartlett, Anna Montgomery, Kimberly Hammer, Siddharth Singhal, and Tze Shien Lo, was published online in AJIC on May 11, 2023. The article may be found at: https://doi.org/10.1016/j.ajic.2023.02.017
AUTHORS
Ashley Bartlett, MD, Fargo VA Healthcare System, Fargo, North Dakota, USA
Anna Montgomery, MPH (corresponding author: denee.montgomery@hotmail.com), Palo Alto VA Healthcare System , Palo Alto, California, USA
Kimberly Hammer, PhD, Fargo VA Healthcare System, Fargo, North Dakota, USA
Siddharth Singhal, MD, Fargo VA Healthcare System, Fargo, North Dakota, USA
Tze Shien Lo, MD, Fargo VA Healthcare System, Fargo, North Dakota, USA
# # #
[1] Centers for Disease Control and Prevention. Clostridioides difficile Infection. https://www.cdc.gov/HAI/organisms/cdiff/Cdiff_infect.html. Published 2019.
[2] The Joint Commission Center for Transforming Healthcare. (2016). Reducing Clostridium Difficile Infections Project. Oakbrook Terrace: The Joint Commission.
[3] Sandhu BK, McBride SM. Clostridioides difficile. Trends Microbiol. 2018;26:1049–1050.
[4] Kang M, Abeles SR, El-Kareh R, et al. The effect of Clostridioides difficile diagnostic stewardship interventions on the diagnosis of hospital-onset Clostridioides difficile infections. Joint Commission J Quality Patient Safety. 2020;46:457–463.
END
COLUMBUS, Ohio – Doctors have long stressed the importance of maintaining a healthy weight for improving overall health, but a large new study also suggests it could also reduce future gastrointestinal cancer (GI) risk.
The study, published today in JAMA Network Open, found that an overweight or obese body mass index (BMI) in early and middle adulthood is associated with increased risk for gastrointestinal cancer. The study also found that frequent aspirin use did not modify this increased risk in overweight and obese individuals.
Colorectal cancer is the third most common cancer among men and women in the United ...
In a groundbreaking new collaboration, scientists at the Center for Advanced Bioenergy and Bioproducts Innovation (CABBI) have identified the types of microbes that associate with engineered oilcane. Further exploration of the oilcane microbiome may reveal opportunities to leverage plant-microbial interactions in these feedstocks, which could increase oil yields for sustainable bioenergy production.
In terms of biomass, sugarcane is the world’s most-produced crop, and it’s not hard to see why; it provides the feedstock for 26% of the world’s bioethanol and 80% of global ...
Scientists at Simon Fraser University (SFU) and the Lankenau Institute for Medical Research (LIMR) near Philadelphia have found that a drug discovered at SFU and patented several years ago may have potential lifesaving results in the treatment of conditions leading to sudden cardiac death.
The drug, known as AR-787, was originally discovered and designed by former PhD student Mena Abdelsayed as a pharmacological solution for arrhythmias.
The so-called J Wave syndromes (JWS), consisting of Brugada syndrome and early repolarization syndromes, occur in about ...
The behaviors and actions of hypersocial species like humans are heavily influenced by the behaviors and actions of those around them. This was evidenced throughout the COVID-19 pandemic; protective measures such as masking and social distancing varied widely as these behaviors were affected by where people were and who they were around, which in turn affected disease prevalence and transmission rates.
Now, researchers from the School of Arts & Science at the University of Pennsylvania and Queen’s University in Canada have produced a theoretical model for disease ...
Researchers at the University of São Paulo (USP) in Brazil have created an exercise training program that survivors of severe COVID-19 can safely perform at home as rehabilitation therapy for persistent symptoms after they are discharged from hospital. Findings of a study recently reported in the British Journal of Sports Medicine show that exercise can improve the quality of life for these patients, benefitting their health and functionality while reducing the number of persistent symptoms, such as muscle pain and weakness.
Long COVID (also known as post-COVID-19 syndrome) affects more than 40% of people who ...
DURHAM, N.C. – In 787 communities served by the United States’ largest utilities, 17 percent of households struggle to afford basic water services, according to a new analysis by researchers at Duke University.
Nearly half the U.S. population lives in the communities covered by the analysis, which was published May 10 in the open-access journal PLOS Water. The analysis shows that 28.3 million people in those communities live in households that spend more than one day each month working to pay for water ...
ATLANTA—A novel type of protein nanoparticle vaccine formulation containing influenza proteins and adjuvant to boost immune responses has provided complete protection against influenza viral challenges, according to a new study published by researchers in the Institute for Biomedical Sciences at Georgia State University.
The findings published in the journal Small describe a promising influenza vaccine candidate that uses adjuvants, substances that increase immune response to a vaccine, to boost effectiveness against ...
CHICAGO, May 10, 2023 – For many people, there are few sounds as relaxing as ocean waves. But the sound of the seas can also convey deeper emotions and raise awareness about pollution.
At the upcoming 184th Meeting of the Acoustical Society of America, Colin Malloy of Ocean Network Canada will present his method to transform ocean data into captivating, solo percussion songs. The talk, “Sonification of ocean data in art-science,” will take place Wednesday, May 10, at 3:25 p.m. in the Indiana/Iowa room. The meeting will run May 8-12 at the Chicago Marriott Downtown Magnificent Mile Hotel.
To construct his compositions, Malloy employs sound from ...
EMBARGOED FOR RELEASE UNTIL 4 P.M. ET, WEDNESDAY, MAY 10, 2023
MINNEAPOLIS – People who have sleep apnea and spend less time in deep sleep may be more likely to have brain biomarkers that have been linked to an increased risk of stroke, Alzheimer’s disease and cognitive decline, according to new research published in the May 10, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study does not prove that these sleep disturbances cause the changes ...
Humans smell. Each and every person has a unique body odor.
People have been using commercial products to alter their scent for generations. From soaps to perfumes, people gravitate to floral and fruity smells.
Whether we think these smells are good or bad is of little consequence to mosquitoes, transmitters of diseases that kill hundreds of thousands of people each year. Additionally, mosquitoes rely on plant nectar to get some sugars needed to sustain their metabolism in addition to needing nutrients in the blood to produce eggs.
And humans with nutrients and a floral scent? That’s two strikes.
In spite of these scents being right under humans’ noses, the impact of ...
