Becker's Clinical Quality & Infection Control

6 INFECTION CONTROL The case for letting nurses initiate C. diff testing By Mackenzie Bean A llowing bedside nurses to independently order Clostridioides difficile testing could help hospitals lower the risk of patient infections and associated deaths, according to a study published May 11 in the American Journal of Infection Control. For the study, researchers at the Fargo (N.D.) VA Healthcare System allowed hospital nurses to independently order stool samples for patients displaying C. diff symptoms without requiring a physician's sign-off. Researchers then compared outcomes in the 44 months before the policy change and the 59 months aer. Four findings: 1. e percentage of positive and negative tests did not change significantly, suggesting the new policy did not result in more unnecessary testing or financial burden for the hospital. 2. e average time to obtain test results fell from 2.1 hours before the policy change to 1.3 hours aer. 3. Nurses were also associated with faster test results compared to physicians aer the policy change (1.2 hours compared to 1.3). 4. e time to initiate treatment remained unchanged throughout the study. Researchers suggest this is because nurses still needed physicians' approval to initiate antibiotics. "Allowing bedside nurses more autonomy to order the stool sample significantly decreased the amount of time to receive the results, potentially decreasing the risk of additional infections among patients and decreasing the economic burden on the hospital," researchers concluded. n Stop antibiotics after surgery, says new guidance By Ashleigh Hollowell N ew guidance on surgical site infections calls for physicians to cease antibiotic prophylaxis immediately after surgeries, according to research published May 4 in Infection Control & Hospital Epidemiology. It is the first major revision to the guidelines since 2014. Prior to now, antibiotics were given often before, during and after to prevent infection, however research has found "no evidence that continuing antibiotics after a patient's incision has been closed, even if it has drains, prevents surgical site infections." Rather, it actually increases a patients' risk for contracting Clostridioides difficile — which can cause severe diarrhea. On top of that, continuing to administer antibiotics afterward also increases the risk for antimicrobial resistance — which has been deemed a growing problem across the globe by the World Health Organization. The new guidance was determined through a collaboration between the Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, Association for Professionals in Infection Control and Epidemiology, the American Hospital Association and The Joint Commission. n Debate over masking in healthcare settings persists post-PHE By Erica Carbajal N ow is not the time to do away with masks in healthcare settings, two infectious disease physicians wrote in a commentary published May 16 in Annals of Internal Medicine, an indication that the debate over whether hospitals should continue to mandate masking is not wavering any time soon. "Although gold-standard evidence is not available, we argue that, despite the lack of clinical efficacy trials (as with the widely accepted practice of hand hygiene), masking in interactions between patients and healthcare personnel should continue to receive serious consideration as a patient safety measure," wrote Tara Palmore, MD, professor of medicine in the division of infectious diseases at Washington, D.C.-based George Washington University, and David Henderson, MD, of the NIH Clinical Center. They highlighted the "notorious" prevalence of presenteeism in healthcare, or when staff show up to work while ill, as a key factor to support continued use of masking after the end of the COVID-19 public health emergency. "Hospitals serving elderly and immunocompromised patients, such as oncology patients and stem-cell and organ transplant recipients, face challenges when deescalating measures that protect these patient populations," the physicians wrote. The commentary comes about one month after researchers published findings from a large hospital in London that indicated removing mask rules for visitors and staff did not result in a "statistically significant change" in the rate of COVID-19 infections. Dozens of U.S. hospitals have walked back universal masking since March. n

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