Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-05T06:58:55.565Z Has data issue: false hasContentIssue false
  • English
  • Français

Development of a novel prevention bundle for pediatric healthcare-associated viral infections

Published online by Cambridge University Press:  20 July 2018

Hillary Hei ,
Orysia Bezpalko ,
Sarah A. Smathers ,
Susan E. Coffin  and
Julia S. Sammons
Hillary Hei
Affiliation:
Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Orysia Bezpalko
Affiliation:
Performance Improvement, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Sarah A. Smathers
Affiliation:
Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Susan E. Coffin
Affiliation:
Infectious Disease, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Julia S. Sammons*
Affiliation:
Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Infectious Disease, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
*
Author for correspondence: Julia Sammons, MD, MSCE, Children’s Hospital of Philadelphia Department of Infection Prevention and Control, 3500 Civic Center Boulevard, Buerger Building Suite P1005, Philadelphia PA 19104. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To reduce the healthcare-associated viral infection (HAVI) rate to 0.70 infections or fewer per 1,000 patient days by developing and sustaining a comprehensive prevention bundle.

Setting

A 546-bed quaternary-care children’s hospital situated in a large urban area.

Patients

Inpatients with a confirmed HAVI were included. These HAVIs were identified through routine surveillance by infection preventionists and were confirmed using National Healthcare Safety Network definitions for upper respiratory infections (URIs), pneumonia, and gastroenteritis.

Methods

Quality improvement (QI) methods and statistical process control (SPC) analyses were used in a retrospective observational analysis of HAVI data from July 2012 through June 2016.

Results

In total, 436 HAVIs were identified during the QI initiative: 63% were URIs, 34% were gastrointestinal infections, and 2.5% were viral pneumonias. The most frequent pathogens were rhinovirus (n=171) and norovirus (n=83). Our SPC analysis of HAVI rate revealed a statistically significant reduction in March 2014 from a monthly average of 0.81 to 0.60 infections per 1,000 patient days. Among HAVIs with event reviews completed, 15% observed contact with a sick primary caregiver and 15% reported contact with a sick visitor. Patient outcomes identified included care escalation (37%), transfer to ICU (11%), and delayed discharge (19%).

Conclusions

The iterative development, implementation, and refinement of targeted prevention practices was associated with a significant reduction in pediatric HAVI. These practices were ultimately formalized into a comprehensive prevention bundle and provide an important framework for both patient and systems-level interventions that can be applied year-round and across inpatient areas.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 9 , September 2018 , pp. 1086 - 1092
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Cite this article: Hei H, et al. (2018) Development of a novel prevention bundle for pediatric healthcare-associated viral infections. Infection Control & Hospital Epidemiology 2018, 39, 1086–1092. doi: 10.1017/ice.2018.149

References

1. Matias, G, Taylor, R, Haguinet, F, Schuck-Pain, C, Lustig, R, Shinde, V. Estimates of hospitalization attributable to influenza and RSV in the US during 1997–2009, by age and risk status. BMC Public Health 2017;17:271.Google Scholar
2. Hall, CB, Weinberg, GA, Blumkin, AK, et al. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics 2013;132:e341–e348.Google Scholar
3. Payne, DC, Vinjé, J, Szilagyi, PG, et al. Norovirus and medically attended gastroenteritis in US children. N Engl J Med 2013;368:1121–1130.Google Scholar
4. Valentini, D, Ianiro, G, Di Bartolo, I, et al. Hospital-acquired rotavirus and norovirus acute gastroenteritis in a pediatric unit, in 2014–2015. J Med Virol 2017;9999:1–7.Google Scholar
5. Gleizes, O, Desselberger, U, Tatochenko, V, et al. Nosocomial rotavirus infection in European countries: a review of the epidemiology, severity and economic burden of hospital-acquired rotavirus disease. Pediatr Infect Dis J 2006;25:S12–S21.Google Scholar
6. Langley, JM, LeBlanc, JC, Wang, EE, et al. Nosocomial respiratory syncytial virus infection in Canadian pediatric hospitals: a Pediatric Investigators Collaborative Network on infections in Canada study. Pediatrics 1997;100:943–946.Google Scholar
7. Gagneur, A, Sizun, J, Vallet, S, Legr, MC, Picard, B, Talbot, PJ. Coronavirus-related nosocomial viral respiratory infections in a neonatal and paediatric intensive care unit: a prospective study. J Hosp Infect 2002;51:59–64.Google Scholar
8. Fisher, BT, Danziger-Isakov, L, Sweet, LR, et al. A multicenter consortium to define the epidemiology and outcomes of inpatient respiratory viral infections in pediatric hemapoietic stem cell transplant recipients. J Pediatric Infect Dis Soc 2017;00:1–8.Google Scholar
9. Spaeder, MC, Fackler, JC. Hospital-acquired viral infection increases mortality in children with severe viral respiratory infection. Pediatr Crit Care Med 2011;12:e317–e321.Google Scholar
10. Weedon, KM, Rupp, AH, Heffron, AC, et al. The impact of infection control upon hospital-acquired influenza and respiratory syncytial virus. Infect Dis (Lond) 2013;45:297–303.Google Scholar
11. Yi, J, Sederdahl, BK, Wahl, K, et al. Rotavirus and norovirus in pediatric healthcare-associated gastroenteritis. Open Forum Infect Dis 2016;3:1–3.Google Scholar
12. Simon, A, Muller, A, Khurana, K, et al. Nosocomial infection: a risk factor for a complicated course in children with respiratory syncytial virus infection—results from a prospective multicenter German surveillance study. Int J Hyg Environ Health 2008;211:241–250.Google Scholar
13. Kramer, A, Schwebke, I, Kampf, G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006;6:130.Google Scholar
14. Boone, SA, Gerba, CP. Significance of fomites in the spread of respiratory and enteric viral disease. Appl Environ Microbiol 2007;73:1687–1696.Google Scholar
15. Barclay, L, Park, GW, Vega, E, et al. Infection control for norovirus. Clin Microbiol Infect 2014;20:731–740.Google Scholar
16. Milstone, AM, Perl, TM, Valsamakis, A. Epidemiology of respiratory viruses in children admitted to an infant/toddler unit. Am J Infect Control 2012;40:462–464.Google Scholar
17. Quach, C, Shah, R, Rubin, LG. Burden of healthcare-associated viral respiratory infections in children’s hospitals. J Pediatric Infect Dis Soc 2016;00:1–7.Google Scholar
18. National Healthcare Safety Network Patient Safety Component Manual, Chapter 17. National Healthcare Safety Network website. https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf. Published 2017. Accessed July 8, 2017.Google Scholar
19. Kimberlin, DW, Brady, MT, Jackson, MA, Long, SS. Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015.Google Scholar
20. Ogrinc, G, Davies, L, Goodman, D, Batalden, P, Davidoff, F, Stevens, D. SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf 2016;25:986–992.Google Scholar
21. Langley, GL, Moen, R, Nolan, KM, Nolan, TW, Norman, CL, Provost, LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed. San Francisco, CA: Jossey-Bass; 2009.Google Scholar
22. Sax, H, Allegranzi, B, Uckay, I, Larson, E, Boyce, J, Pittet, D. ‘My five moments for hand hygiene’: a user-centered design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007;67:9–21.Google Scholar
23. Jena, AB, Baldwin, DC, Daugherty, SR, Meltzer, DO, Arora, VM. Presenteeism among resident physicians. JAMA 2010;304:1166–1168.Google Scholar
24. Mitchell, KJ, Vayalumkal, JV. Sickness presenteeism: the prevalence of coming to work while ill among paediatric resident physicians in Canada. J Paediatr Child Health 2017;22:84–88.Google Scholar
25. Szymczak, JE, Smathers, S, Hoegg, C, Klieger, S, Coffin, SE, Sammons, JS. Reasons why physicians and advanced practice clinicians work while sick: a mixed-methods analysis. JAMA Pediatrics 2015;169:815–821.Google Scholar
26. Boyce, JM, Havill, NL, Dumigan, DG, Golebiewski, M, Balogun, O, Rizvani, R. Monitoring the effectiveness of hospital cleaning practices by use of an adenosine triphosphate bioluminescence assay. Infect Control Hosp Epidemiol 2009;30:678–684.Google Scholar
27. Moore, G, Smyth, D, Singleton, J, Wilson, P. The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting. Am J Infect Control 2010;38:617–622.Google Scholar
28. Huang, YS, Chen, YC, Chen, ML, et al. Comparing visual inspection, aerobic colony counts, and adenosine triphosphate bioluminescence assay for evaluating surface cleanliness at a medical center. Am J Infect Control 2015;43:882–886.Google Scholar
29. Wheeler, DJ, Chambers, DS. Understanding Statistical Process Control. 3rd ed. Knoxville, TN: SPC Press; 2010.Google Scholar
30. Provost, LP, Murray, SK. The Health Care Data Guide: Learning from Data for Improvement. San Francisco, CA: Jossey-Bass; 2011.Google Scholar
31. StataCorp. 2011 Stata Statistical Software: Release 12. College Station, TX: StataCorp LP.Google Scholar
32. Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–381.Google Scholar
33. Banach, DB, Bearman, GM, Morgan, DJ, Munoz-Price, LS. Infection control precautions for visitors to healthcare facilities. Expert Rev Anti Infect Ther 2015;13:1047–1050.Google Scholar
34. Munoz-Price, LS, Banach, DB, Bearman, G, et al. Isolation precautions for visitors. Infect Control Hosp Epidemiol 2015;36:747–758.Google Scholar
35. Edwards, JD, Herzig, CT, Liu, H, et al. Central line-associated blood stream infections in pediatric intensive care units: longitudinal trends and compliance with bundle strategies. Am J Infect Control 2015;43:489–493.Google Scholar
36. Azab, SF, Sherbiny, HS, Saleh, SH, et al. Reducing ventilator-associated pneumonia in neonatal intensive care unit using “VAP Prevention Bundle”: a cohort study. BMC Infect Dis 2015;15:314.Google Scholar
37. Davis, KF, Colebaugh, AM, Eithun, BL, et al. Reducing catheter-associated urinary tract infections: a quality-improvement initiative. Pediatrics 2014;134:e857–e864.Google Scholar
38. Mitchell, C, Meredith, P, Richardson, M, Greengross, P, Smith, GB. Reducing the number and impact of outbreaks of nosocomial viral gastroenteritis: time-series analysis of a multidimensional quality improvement initiative. BMJ Qual Saf 2016;25:466–474.Google Scholar
Supplementary material: File

Hei et al. supplementary material

Appendices A-D

Download Hei et al. supplementary material(File)
File 32.4 KB