Improving Stethoscope Disinfection at a Children's Hospital

Objective.Stethoscopes are contaminated with pathogenic bacteria and pose a risk for transmission of infections, but few clinicians disinfect their stethoscope after every use. We sought to improve stethoscope disinfection rates among pediatric healthcare providers by providing access to disinfection materials and visual reminders to disinfect stethoscopes.Design.Prospective intervention study.Setting. Inpatient units and emergency department of a major pediatric hospital.Participants.Physicians and nurses with high anticipated stethoscope use.Methods.Baskets filled with alcohol prep pads and a sticker reminding providers to regularly disinfect stethoscopes were installed outside of patient rooms. Healthcare providers' stethoscope disinfection behaviors were directly observed before and after the intervention. Multivariable logistic regression models were created to identify independent predictors of stethoscope disinfection.Results.Two hundred twenty-six observations were made in the preintervention period and 261 in the postintervention period (83% were of physicians). Stethoscope disinfection compliance increased significantly from a baseline of 34% to 59% postintervention (P < .001). In adjusted analyses, the postintervention period was associated with improved disinfection among both physicians (odds ratio [OR], 2.3 [95% confidence interval (CI), 1.4-3.5]) and nurses (OR, 14.3 [95% CI, 4.6-44.6]). Additional factors independently associated with disinfection included subspecialty unit (vs general pediatrics; OR, 0.5 [95% CI, 0.3-0.8]) and contact precautions (OR, 2.3 [95% CI, 1.2-4.1]).Conclusions.Providing stethoscope disinfection supplies and visible reminders outside of patient rooms significantly increased stethoscope disinfection rates among physicians and nurses at a children's hospital. This simple intervention could be replicated at other healthcare facilities. Future research should assess the impact on patient infections.

Download Full-text

81. Children and COVID-19 in Colorado: The Children’s Hospital Colorado Experience

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.391 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S172-S173

Author(s):

Kelly E Graff ◽

Lori Silveira ◽

Jane Jarjour ◽

Shane Curran-Hays ◽

Lauren Carpenter ◽

...

Keyword(s):

Hospital Admission ◽

Wide Spectrum ◽

Severe Disease ◽

Tertiary Care ◽

Pediatric Intensive Care ◽

Respiratory Support ◽

Logistic Regression Models ◽

Children's Hospital ◽

Children’S Hospital ◽

The Impact

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease of 2019 (COVID-19) and has been reported in > 98,000 children in the U.S (5% of reported cases) as of early June 2020. Most published literature focuses on adults with COVID-19, but little is understood on the impact of SARS-CoV-2 in children. We created a database for children with COVID-19 at Children’s Hospital Colorado (CHCO), a large tertiary care pediatric hospital, to better understand the epidemiology and clinical outcomes of this disease in children. Methods We retrospectively reviewed the medical records of all pediatric and youth patients with positive SARS-CoV-2 PCR test results from March-May 2020. Univariate logistic regression models were used to identify predictors of hospital admission, need for critical care, and need for respiratory support among symptomatic patients, with p-values < 0.05 considered statistically significant. Results We identified 246 patients with SARS-CoV-2 (age range: 17 days-25 years). We noted a Hispanic predominance with 68% of all patients with SARS-CoV-2 identifying as Hispanic or Latino, compared to 29% among all CHCO visits in 2019 (Figure 1). The most common symptoms at presentation were fever, cough, or shortness of breath in 94% of symptomatic patients. Sixty-eight patients (28%) were admitted, of which 7 (10%) required admission to the pediatric intensive care unit (PICU) for symptomatic COVID-19 disease (Figure 2). Age 0–3 months, certain symptoms at presentation, and several types of underlying medical conditions were predictors for both hospital admission and need for respiratory support (Figure 3). Initial and peak C-reactive protein (CRP) values were predictors for PICU admission with median peaks of 24.8mg/dL vs. 2.0mg/dL among PICU vs. non-PICU patients (OR 1.27, p=0.004). Figure 3: Predictors for Admission and Respiratory Support Requirement in CHCO Patients with SARS-CoV-2 Conclusion There is a wide spectrum of illness in children with SARS-CoV-2, ranging from asymptomatic to critical illness. Hispanic ethnicity was disproportionately represented in our cohort, which requires further evaluation. We found that young age, comorbid conditions, and CRP appear to be risk factors for severe disease in children. Disclosures Kelly E. Graff, MD, BioFire Diagnostics, LLC (Grant/Research Support)

Download Full-text

Analysis of the Design Process of Green Children's Hospitals: Focus on Process Modeling and Lessons Learned

Journal of Green Building ◽

10.3992/jgb.4.1.121 ◽

2009 ◽

Vol 4 (1) ◽

pp. 121-134 ◽

Cited By ~ 10

Author(s):

M.M Bilec ◽

R.J Ries ◽

K.L Needy ◽

M Gokhan ◽

A.F Phelps ◽

...

Keyword(s):

Design Process ◽

Medical Center ◽

Children's Hospitals ◽

Healthcare Facilities ◽

Children's Hospital ◽

Children’S Hospitals ◽

Complex Design ◽

Children’S Hospital ◽

Design Requirements ◽

The Impact

Healthcare facilities are among the most complicated facilities to plan, design, construct and operate. A new breed of hospitals is considering the impact of the built environment on healthcare worker productivity and patient recovery in their design, construction, and operation. A crucial subset of healthcare facilities are children's hospitals where the consequences of poor building system design and performance have the potential to seriously impact young lives with compromised health. Green facilities are not always pursued: they are perceived as difficult to build and costing more than equivalent conventional hospitals. This study explored the design process of the Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) and Penn State's Hershey Medical Center Children's Hospital to understand the critical steps and processes for green children's hospital design. Producing a series of process maps that identify the key characteristics in the complex design requirements of a green children's hospital, this paper reveals the importance of design process to design quality. More broadly, this research will help future project teams meet the complex design requirements of green children's hospitals.

Download Full-text

Impact of discontinuation of contact precautions on central-line associated bloodstream infections in an academic children’s hospital

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.19 ◽

2019 ◽

Vol 40 (4) ◽

pp. 473-475 ◽

Cited By ~ 4

Author(s):

Emily J. Godbout ◽

Barry J. Rittmann ◽

Michele Fleming ◽

Heather Albert ◽

Yvette Major ◽

...

Keyword(s):

Infection Prevention ◽

Bloodstream Infections ◽

Central Line ◽

Adverse Impact ◽

Infection Rates ◽

Children's Hospital ◽

Contact Precautions ◽

Children’S Hospital ◽

Vancomycin Resistant ◽

The Impact

AbstractWe investigated the impact of discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus infected or colonized patients on central-line associated bloodstream infection rates at an academic children’s hospital. Discontinuation of contact precautions with a bundled horizontal infection prevention platform resulted in no adverse impact on CLABSI rates.

Download Full-text

Pediatric Surgical Reentry Strategy Following the COVID-19 Pandemic: A Tiered and Balanced Approach

The American Surgeon ◽

10.1177/00031348211011125 ◽

2021 ◽

pp. 000313482110111

Author(s):

Ryan C. Pickens ◽

Angela M. Kao ◽

Mark A. Williams ◽

Andrew C. Herman ◽

Jeffrey S. Kneisl

Keyword(s):

Pediatric Surgery ◽

Elective Surgery ◽

Surgical Care ◽

Children's Hospital ◽

Protocol Development ◽

Balanced Approach ◽

Projective Curves ◽

Children’S Hospital ◽

The Impact ◽

Emergent Surgery

Background In response to the COVID-19 pandemic, children’s hospitals across the country postponed elective surgery beginning in March 2020. As projective curves flattened, administrators and surgeons sought to develop strategies to safely resume non-emergent surgery. This article reviews challenges and solutions specific to a children’s hospital related to the resumption of elective pediatric surgeries. We present our tiered reentry approach for pediatric surgery as well as report early data for surgical volume and tracking COVID-19 cases during reentry. Methods The experience of shutdown, protocol development, and early reentry of elective pediatric surgery are reported from Levine’s Children’s Hospital (LCH), a free-leaning children’s hospital in Charlotte, North Carolina. Data reported were obtained from de-identified hospital databases. Results Pediatric surgery experienced a dramatic decrease in case volumes at LCH during the shutdown, variable by specialty. A tiered and balanced reentry strategy was implemented with steady resumption of elective surgery following strict pre-procedural screening and testing. Early outcomes showed a steady thorough fluctuating increase in elective case volumes without evidence of a surgery-associated positive spread through periprocedural tracking. Conclusion Reentry of non-emergent pediatric surgical care requires unique considerations including the impact of COVID-19 on children, each children hospital structure and resources, and preventing undue delay in intervention for age- and disease-specific pediatric conditions. A carefully balanced strategy has been critical for safe reentry following the anticipated surge. Ongoing tracking of resource utilization, operative volumes, and testing results will remain vital as community spread continues to fluctuate across the country.

Download Full-text

Handshake antimicrobial stewardship as a model to recognize and prevent diagnostic errors

Diagnosis ◽

10.1515/dx-2020-0032 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Justin B. Searns ◽

Manon C. Williams ◽

Christine E. MacBrayne ◽

Ann L. Wirtz ◽

Jan E. Leonard ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Interrater Reliability ◽

Diagnostic Errors ◽

Diagnostic Error ◽

Primary Treatment ◽

Treatment Team ◽

Children's Hospital ◽

Children’S Hospital ◽

The Impact ◽

Made In

AbstractObjectivesFew studies describe the impact of antimicrobial stewardship programs (ASPs) on recognizing and preventing diagnostic errors. Handshake stewardship (HS-ASP) is a novel ASP model that prospectively reviews hospital-wide antimicrobial usage with recommendations made in person to treatment teams. The purpose of this study was to determine if HS-ASP could identify and intervene on potential diagnostic errors for children hospitalized at a quaternary care children’s hospital.MethodsPreviously self-identified “Great Catch” (GC) interventions by the Children’s Hospital Colorado HS-ASP team from 10/2014 through 5/2018 were retrospectively reviewed. Each GC was categorized based on the types of recommendations from HS-ASP, including if any diagnostic recommendations were made to the treatment team. Each GC was independently scored using the “Safer Dx Instrument” to determine presence of diagnostic error based on a previously determined cut-off score of ≤1.50. Interrater reliability for the instrument was measured using a randomized subset of one third of GCs.ResultsDuring the study period, there were 162 GC interventions. Of these, 65 (40%) included diagnostic recommendations by HS-ASP and 19 (12%) had a Safer Dx Score of ≤1.50, (Κ=0.44; moderate agreement). Of those GCs associated with diagnostic errors, the HS-ASP team made a diagnostic recommendation to the primary treatment team 95% of the time.ConclusionsHandshake stewardship has the potential to identify and intervene on diagnostic errors for hospitalized children.

Download Full-text

The impact of a ‘milking the COW’ campaign in a regional hospital in Singapore

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-00948-1 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Surinder Kaur M. S. Pada ◽

Poh Lishi ◽

Kim Sim Ng ◽

Sarathamani Rethenam ◽

Lilibeth Silagan Alenton ◽

...

Keyword(s):

Hand Hygiene ◽

Pathogenic Bacteria ◽

Mixed Model ◽

Mixed Model Analysis ◽

Colony Forming Units ◽

Skin Flora ◽

Before And After ◽

The Difference ◽

And Control ◽

The Impact

Abstract Background Computerisation of various processes in hospitals and reliance on electronic devices raises the concern of contamination of these devices from the patient environment. We undertook this study to determine if an attached hand hygiene device that unlocks the screen of a computer on wheels (COW) on usage can be effective in decreasing the microbiological burden on computer keyboards. Methods An electronic hand sanitizer was integrated onto the COW. A prospective cohort study with a crossover design involving 2 control and 2 intervention wards was used. The study end point was the number of colony forming units found on the keyboards. Bacteria were classified into 4 main groups; pathogenic, skin flora, from the environment or those thought to be commensals in healthy individuals. We then used a mixed effects model for the statistical analysis to determine if there were any differences before and after the intervention. Results Thirty-nine keyboards were swabbed at baseline, day 7 and 14, with 234 keyboards cultured, colony forming units (CFUs) counted and organisms isolated. By mixed model analysis, the difference of mean bacteria count between intervention and control for week 1 was 32.74 (− 32.74, CI − 94.29 to 28.75, p = 0.29), for week 2 by 155.86 (− 155.86, CI − 227.45 to − 83.53, p < 0.0001), and after the 2-week period by 157.04 (− 157.04, CI − 231.53 to − 82.67, p < 0.0001). In the sub-analysis, there were significant differences of pathogenic bacteria counts for the Intervention as compared to the Control in contrast with commensal counts. Conclusion A hand hygiene device attached to a COW may be effective in decreasing the microbiological burden on computer keyboards.

Download Full-text

The impact of a complex care clinic in a children's hospital

Child Care Health and Development ◽

10.1111/j.1365-2214.2009.01069.x ◽

2010 ◽

Vol 36 (4) ◽

pp. 574-582 ◽

Cited By ~ 16

Author(s):

E. Cohen ◽

J. N. Friedman ◽

S. Mahant ◽

S. Adams ◽

V. Jovcevska ◽

...

Keyword(s):

Complex Care ◽

Care Clinic ◽

Children's Hospital ◽

Children’S Hospital ◽

The Impact

Download Full-text

Review of Best Practices for CLABSI Prevention and the Impact of Recent Legislation on CLABSI Reporting

SAGE Open ◽

10.1177/2158244016677747 ◽

2016 ◽

Vol 6 (4) ◽

pp. 215824401667774 ◽

Cited By ~ 1

Author(s):

Benjamin Woodward ◽

Reba Umberger

Keyword(s):

Best Practices ◽

Healthcare Providers ◽

Bloodstream Infections ◽

Central Line ◽

Mandatory Reporting ◽

Future Research ◽

Common Source ◽

Healthcare Associated Infection ◽

Extrinsic Factors ◽

The Impact

Central line-associated bloodstream infections (CLABSI) are a very common source of healthcare-associated infection (HAI). Incidence of CLABSI has been significantly reduced through the efforts of nurses, healthcare providers, and infection preventionists. Extrinsic factors such as recently enacted legislation and mandatory reporting have not been closely examined in relation to changes in rates of HAI. The following review will examine evidence-based practices related to CLABSI and how they are reported, as well as how the Affordable Care Act, mandatory reporting, and pay-for-performance programs have affected these best practices related to CLABSI prevention. There is a disconnect in the methods and guidelines for reporting CLABSI between these programs, specifically among local monitoring agencies and the various federal oversight organizations. Future research will focus on addressing the gap in what defines a CLABSI and whether or not these programs to incentivize hospital to reduce CLABSI rates are effective.

Download Full-text

Using geospatial models to map zero-dose children: factors associated with zero-dose vaccination status before and after a mass measles and rubella vaccination campaign

10.1101/2021.09.16.21263705 ◽

2021 ◽

Author(s):

Rohan Arambepola ◽

Yangyupei Yang ◽

Kyle Hutchinson ◽

Francis D Mwansa ◽

Julie Ann Doherty ◽

...

Keyword(s):

Vaccination Campaign ◽

Fine Scale ◽

Healthcare Facilities ◽

Factors Associated ◽

Catchment Areas ◽

Before And After ◽

Childhood Vaccines ◽

A Prospective Study ◽

Vaccination Campaigns ◽

The Impact

Introduction: Despite gains in global coverage of childhood vaccines, many children remain undervaccinated. Vaccination campaigns also known as Supplemental Immunization Activity (SIA) are commonly conducted to reach those who are undervaccinated. However, reaching these children even during an SIA is challenging. We evaluated the effectiveness of an SIA in reaching zero dose children. Methods: We conducted a prospective study in 10 health center catchment areas in Southern province, Zambia in November 2020. About 2 months before the measles and rubella SIA we developed aerial satellite maps which were then used to enumerate and survey households. Zero dose children were identified during this exercise. After the SIA, households with zero dose children identified before the SIA were targeted for mop up vaccination and to assess if they were vaccinated during the SIA. A Bayesian geospatial model was used to identify factors associated with zero-dose status before the campaign and produce fine-scale prevalence maps. Models were used to identify factors associated with measles zero-dose children reached in the campaign and identify optimal locations for additional vaccination sites. Results: Before the vaccination campaign, 4% of children under 9 months were DTP zero-dose and 17% of children 9-60 months were measles zero-dose. Of the 461 measles zero-dose children identified before the vaccination campaign, 338 (73.3%) were vaccinated during the campaign, 118 (25.6%) were reached by a targeted mop-up activity. The presence of other children in the household, younger age, greater travel time to health facilities, and living between health facility catchment areas were associated with zero-dose status. Mapping zero-dose prevalence revealed substantial heterogeneity, both within and between catchment areas. Several potential locations were identified for additional vaccination sites. Conclusion: Fine-scale variation in zero-dose prevalence and the impact of accessibility to healthcare facilities on vaccination coverage were identified. Geospatial modeling can aid targeted vaccination activities.

Download Full-text