Reduction in Health Care Facility-Onset Clostridioides difficile Infection: A Quality Improvement Initiative.

OBJECTIVE: To reduce health care facility-onset (HCFO) Clostridioides difficile infection (CDI) incidence by improving diagnostic stewardship and reducing the inappropriate testing of C difficile assays. PATIENTS AND METHODS: A multidisciplinary team conducted a quality improvement initiative from January 1, 2020, through March 31, 2021. Clostridioides difficile infection and inappropriate testing were identified via electronic health records using predefined criteria related to stool quantity/caliber, confounding medications, and laboratory data. An intervention bundle was designed including (1) provider education, (2) implementation of an appropriate testing algorithm, (3) expert review of C difficile orders, and (4) batch testing of assays to facilitate review and cancellation if inappropriate. RESULTS: Compared with a baseline period from January to September 2020, implementation of our intervention bundle from December 2020 to March 2021 resulted in an 83.6% reduction in inappropriate orders tested and a 41.7% reduction in HCFO CDI incidence. CONCLUSION: A novel prevention bundle improved C difficile diagnostic stewardship and HCFO CDI incidence by reducing testing of inappropriate orders. Such initiatives targeting HCFO CDI may positively affect patient safety and hospital reimbursement.

Thyroid Dysfunction and Sleep Disorders.

Thyroid disorders and sleep disorders are common problems in the general population that can affect people of all ages, backgrounds, and sexes, but little is known about their clinical associations. We reviewed the literature assessing the associations between thyroid disease and sleep disorders and noted that hyperthyroidism and hypothyroidism have clinical overlap with sleep conditions such as insomnia, restless legs syndrome, and obstructive sleep apnea. These findings highlight the importance of identifying and managing thyroid dysfunction for patients with these common sleep disorders. Additional research is needed to further understand how thyroid dysfunction affects sleep physiology.

Muscle-Specific Endurance of the Lower Back Erectors Using Electrical Twitch Mechanomyography.

Lower back pain is a common symptom potentially associated with skeletal muscle dysfunction. The purpose of this study was to evaluate endurance in the lower back muscles of healthy participants using accelerometer-based mechanomyography. Methods: Young healthy subjects (N = 7) were tested. Surface electrodes and a tri-axial accelerometer were placed over the erector spinae muscle along the T11-L1 Vertebrae. Stimulation was for 3 min each at 2, 4, and 6 Hz, and changes in acceleration were used to calculate an endurance index (EI). Reproducibility of the endurance index measurements was tested on two separate days. Wrist flexor and vastus lateralis muscles were tested for comparison. Near Infrared Spectroscopy (NIRS) was used to measure muscle oxygen levels (O2Hb) (N = 5). EI was 70.3 + 13.4, 32.6 + 8.4, and 19.2 + 6.2% for 2, 4, 6 Hz, respectively. The coefficients of variation were 9.8, 13.9, and 20.3% for 2, 4, 6 Hz, respectively. EI values were lower in the erector spinae muscles compared to the arm and the leg (p < 0.05). O2Hb values were 86.4 + 10.9% at rest and were 77.2 + 15.5, 84.3 + 14.1, and 84.1 + 18.9% for 2, 4, 6 Hz, respectively (p > 0.05, all comparisons). An endurance index can be obtained from the lower back erectors muscles that is reproducible and not influenced by voluntary effort or muscle oxygen levels.