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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: sammonsj@email.chop.edu
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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. 

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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

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