The Effect of Clostridioides difficile Diagnostic Stewardship Interventions on the Diagnosis of Hospital-Onset Clostridioides difficile Infections

BackgroundPublic reporting of Clostridioides difficile infection (CDI) using laboratory-identified events has led some institutions to revert from molecular-based tests to less sensitive testing modalities. At one academic medical center, researchers chose to use nucleic acid amplification test alone in CDI diagnosis with institutional protocols aimed at diagnostic stewardship.MethodsA single-center, quasi-experimental study was conducted to introduce and analyze the effects of various diagnostic stewardship interventions. In April 2017 an order report was created to inform providers of patients' recent bowel movements, laxative use, and prior Clostridioides difficile (CD) testing (Intervention 1). In November 2017 nursing staff were empowered to not send nondiarrheal stools for testing (Intervention 2). In February 2019, an interruptive alert was implemented to prevent testing that was not indicated (Intervention 3). CD testing rates and healthcare facility-onset CDI (HO-CDI) rates were compared before and after the interventions using one-way analysis of variance (ANOVA).ResultsAt baseline, testing for CD after 3 days of admission was performed at mean ± standard deviation of 15.9 ± 1.7 tests/1,000 patient-days. After Intervention 1, it decreased to 12.1 ± 1.1 tests. This further decreased to 10.6 ± 0.8 after Intervention 2 and to 8.1 ± 0.1 after Intervention 3 (p < 0.001). HO-CDI cases per 10,000 patient-days declined from 12.7 ± 1.4 cases at baseline to 10.7 ± 1.2 after Intervention 1, to 8.7 ± 2.4 after Intervention 2, and to 5.8 ± 0.2 after Intervention 3 (p = 0.03).ConclusionA multidisciplinary approach optimizing electronic health record support tools and leveraging nursing education can reduce both testing and HO-CDI rates while using the most sensitive testing modality

Adopting Web 2.0 technologies on chain and independent hotel websites: A case study of hotels in Hong Kong

With the unprecedented ability to empower travellers in producing and consuming travel information, Web 2.0 is fundamentally changing the way of traveller’s information search behaviour and affecting subsequent decision making. As such, many researchers asserted that more hotel companies have integrated the technology into their websites to enhance customers’ travel information searching experience. However, no prior studies were conducted on this phenomenon in the hotel context. This study purposes to explore Web 2.0 technology adoption among Hong Kong hotels. The factors influencing the adoption of Web 2.0 technologies are also identified and discussed. A content analysis of hotel websites and interviews with the hotel managers identified the difference in adoption rate between chain and independent hotels. The discrepancy is mainly attributed to the top managements’ perceived benefit of Web 2.0.School of Hotel and Tourism Managemen