A study at a Veterans Affairs (VA) hospital suggests that allowing bedside nurses to independently order testing for Clostridioides difficile infection (CDI) shortened the time to receive test results, researchers reported today in the American Journal of Infection Control.

The policy at the Fargo VA Healthcare System in North Dakota allowed nurses to order stool tests for new patients displaying symptoms of CDI. Prior to the policy, only physicians, pharmacists, or certified nurse practitioners could order stool tests, which resulted in delays in acquiring test results. To test the effectiveness of the new policy, hospital staff compared the frequency of tests being ordered, the time to obtain test results, and the time to initiate treatment for positive test results before and after the change. They also analyzed the difference between nurses and physicians in the time to obtain test results.

The proportion of nurses and physicians ordering stool tests after the policy change was similar (51.1% vs 48.9%, respectively). The percent of positive test results before and after the policy change was relatively unaffected (13.9% vs 11.5%, respectively). But the difference in time to obtain the test result was statistically significant after the policy change (mean [standard deviation (SD)], 2.2 [1.3] vs 1.3 [0.7] hours), as was the time to obtain the test results between nurses and physicians after the policy change (mean [SD], 1.2 [0.7] vs 1.3 [0.7] hours).

Incentives exist for improving approaches to the prevention and spread of this infection.

Although there was no difference in the time to initiate treatment before and after the policy change (1.7 hours), nurses reported that they were able to order contact precautions earlier than they previously would have to prevent the spread of CDI to other patients.

"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," lead study author Ashley Bartlett, MD, said in a press release. "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."

Today in PLoS Water, a new analysis suggests that millions of US households struggle to pay for water and wastewater services because the cost of water utilities has increased substantially in recent years.

The study was based on data from 787 of the largest water utilities in the nation. Researchers used the metric of households spending more than 4.6% of their monthly income on 6,000 gallons of water per month, which is considered sufficient to meet basic household needs. The percentage is roughly equivalent to the pay from one workday.

A total of 17% of households, which included 28.3 million people, spent more than 4.6% of their monthly income on water services. That means an average of 1 in 7 households (15%) can't afford water services, the authors said.

In every community, there are households with unaffordable water services.

The researchers said their findings have wide public health implications, and the reasons behind the increasing water cost is varied but include climate change, aging infrastructure, and lower household incomes.

"We found household water affordability challenges in all utilities, states, and regions of the U.S. In every community, there are households with unaffordable water services even when using the most conservative definitions of undue hardship and volumes of water usage," the authors concluded. "While unaffordable water services are not geographically limited to specific states or regions, there are regional concentrations of unaffordability challenges in eastern regions, particularly within West Virginia, Ohio, and Indiana."

• The US Centers for Disease Control and Prevention (CDC) announced late last week that it is investigating a hepatitis A outbreak linked to frozen organic strawberries imported from Mexico. Nine cases in three states (California, Oregon, and Washington) have been reported, with April 12 as the latest illness onset. Three patients were hospitalized, but no deaths have been reported. Epidemiologic and trace-back investigations point to strawberries imported from Baja, Mexico, in 2022. The hepatitis strain is similar to a 2022 outbreak linked to strawberries from the same area. The outbreak prompted recalls of certain lots of frozen strawberries or products containing sold at retailers such as Costco, Aldi, and Trader Joe's.
• In an update today on global cholera activity, the World Health Organization (WHO) said 1 more country—Eswatini—is reporting an outbreak, bringing the number of affected countries this year to 24. Since the beginning of the year, cholera outbreaks have expanded further across Africa, with the global outbreak response challenged by a lack of resources, limited oral cholera vaccine, and overstretched public health personnel who are juggling multiple outbreaks and emergencies.
• In updates over the past few days, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) has reported one more highly pathogenic avian flu outbreak in a poultry flock, which affected a backyard facility in Indiana's Posey County that housed 20 birds. Also, APHIS reported 44 more H5N1 avian flu detections in wild birds from 18 states, including more endangered condors in Arizona. Most of the other detections involved other birds of prey such as owls, eagles, and hawks, but there were some waterfowl were also infected.