Impact of Mandatory Infectious Disease Specialist Approval on Hospital-Onset Clostridioides difficile Infection Rates and Testing Appropriateness.

BACKGROUND: Inappropriate Clostridioides difficile testing is common in the hospital setting, leading to potential overdiagnosis of infection when single-step nucleic acid amplification testing is used. The potential role of infectious diseases (ID) specialists in enforcing appropriate C. difficile testing is unclear. METHODS: At a single 697-bed academic hospital, we performed a retrospective study from 1 March 2012 to 31 December 2019 comparing hospital-onset C. difficile infection (HO-CDI) rates during 3 consecutive time periods: baseline 1 (37 months, no decision support), baseline 2 (32 months, computer decision support), and intervention period (25 months, mandatory ID specialist approval for all C. difficile testing on hospital day 4 or later). We used a discontinuous growth model to assess the impact of the intervention on HO-CDI rates. RESULTS: During the study period, we evaluated C. difficile infections across 331 180 admission and 1 172 015 patient-days. During the intervention period, a median of 1 HO-CDI test approval request per day (range, 0-6 alerts/day) was observed; adherence by providers with obtaining approval was 85%. The HO-CDI rate was 10.2, 10.4, and 4.3 events per 10 000 patient-days for each consecutive time period, respectively. In adjusted analysis, the HO-CDI rate did not differ significantly between the 2 baseline periods (P = .14) but did differ between the baseline 2 period and intervention period (P < .001). CONCLUSIONS: An ID-led C. difficile testing approval process was feasible and was associated with a >50% decrease in HO-CDI rates, due to enforcement of appropriate testing.

Effect of lavender and rosemary aromatherapy on test anxiety in chiropractic students.

OBJECTIVE: Test anxiety is a debilitating disorder that can impair cognitive performance and affect academic success. Aromatherapy is commonly used for relaxation therapy. The primary aim of the study was to determine if nasal inhaler aromatherapy, utilizing a blend of rosemary and lavender essential oils, could be a useful strategy to reduce testing anxiety in students. METHODS: This study recruited first trimester chiropractic students enrolled in both Neuroanatomy I and Biochemistry I. A randomized crossover design was utilized over 2 study days during final exams, with a 2-day wash-out period. Participants were randomly assigned into groups based on results of test anxiety analysis. On each day, students were given a nasal inhaler with either an aromatherapy blend of lavender and rosemary essential oils or distilled water as the control. Students completed pretest surveys and posttest surveys to rate their anxiety levels. Paired sample t-tests were performed to determine group differences in test anxiety. Both intention-to-treat and per-protocol analyses were conducted. RESULTS: Forty-five students were randomly assigned into the study, whereas only 38 completed per-protocol. Between group comparisons showed no statistically significant difference between change in anxiety scores between aromatherapy and control for both intention-to-treat (p =.10) and per-protocol (p =.07). CONCLUSION: Use of personal inhalers and aromatherapy diffusers were not shown to reduce test anxiety in a chiropractic population under high-stakes examination. Other options should be explored for future research.