scholarly journals A Multidimensional Quality Improvement Initiative to Reduce Pediatric Healthcare-Associated Respiratory Viral Infections

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Hillary Hei ◽  
Cindy Hoegg ◽  
Sarah Smathers ◽  
Susan Coffin ◽  
Julia Shaklee Sammons
Keyword(s):  
Quality Improvement ◽  
Viral Infections ◽  
Quality Improvement Initiative ◽  
Respiratory Viral Infections ◽  
Healthcare Associated ◽  
Pediatric Healthcare

#87: Association Between Healthcare-Associated Respiratory Viral Infections and Length of Stay at a Pediatric Hospital

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S15-S15
Author(s):  
Zachary Most ◽  
Michael Sebert ◽  
Patricia Jackson ◽  
Trish M Perl
Keyword(s):  
Length Of Stay ◽  
Incubation Period ◽  
Respiratory Infection ◽  
Symptom Onset ◽  
Viral Infections ◽  
Pediatric Hospital ◽  
Time Period ◽  
Life Years ◽  
Respiratory Viral Infections ◽  
Healthcare Associated

Abstract Background Healthcare-associated infections (HAI) are major preventable causes of morbidity and mortality. While there are fewer overall HAI in children, there is a greater potential impact in disability-adjusted life years. Healthcare-associated respiratory viral infections (HARVI) are not frequently tracked within institutions, yet the risk for such infections in pediatric hospitals is very high. Recent data demonstrate large inter-hospital variability of HARVI incidence that may depend on various factors including the number of immunocompromised patients in the hospital and the presence of shared rooms. We hypothesize that the burden of healthcare-associated respiratory viral infections and their impact on the length of stay (LOS) is substantial at a large urban pediatric hospital. Methods A cohort of all children with any HARVI admitted to a large urban pediatric hospital between July 2017 and June 2018 were included after obtaining IRB approval. We defined a HARVI as a respiratory infection with an onset of symptoms while the patient was hospitalized meeting three criteria: A positive microbiologic test for one of 8 viruses, presence of symptoms of a respiratory infection, and onset of symptoms after admission beyond the minimum incubation period for each virus. Infections with symptom onset after admission beyond the maximum incubation period were considered definite hospital onset whereas others were considered possible hospital onset. The electronic medical record provided data on demographics, underlying medical conditions, hospital length of stay prior to infection and hospital unit of infection, and consequences and outcome of HARVI. The at-risk population for calculation of the incidence of HARVI was all admitted patient-days at the hospital over this time period. Results Between July 2017 and June 2018 the incidence of HARVI (definite or possible hospital onset) was 1.2 infections per 1,000 admitted patient-days (60% due to rhinovirus/enterovirus, 12% due to respiratory syncytial virus, and 9% due to influenza). Overall, 48% of patients were under 2 years of age, 18% were between 2 and 5 years of age, and 34% were over 5 years of age. Twenty-one percent were immunocompromised and 35% had underlying lung disease. The median length of stay prior to symptom onset was 11 days (IQR 5–36 days) and the median total length of stay was 30 days (IQR 15–82.5 days). Eight individuals had more than one HARVI over this time period. Nineteen percent were transferred to the intensive care unit and 7% died during their hospital admission Conclusion HARVI occurs frequently in a pediatric hospital and often in patients with underlying comorbidities. The risk for HARVI increases substantially with increased length of stay. Such data support the need for tracking HARVI in high-risk institutions.

scholarly journals Focusing on Families and Visitors Reduces Healthcare Associated Respiratory Viral Infections in a Neonatal Intensive Care Unit

2019 ◽  
Vol 4 (6) ◽  
pp. e242 ◽  
Author(s):  
W. Matthew Linam ◽  
Elizabeth M. Marrero ◽  
Michele D. Honeycutt ◽  
Christy M. Wisdom ◽  
Anna Gaspar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Viral Infections ◽  
Respiratory Viral Infections ◽  
Healthcare Associated

scholarly journals 863. Outcomes of Healthcare-Associated Respiratory Viral Infections in a Pediatric Hospital: A Historical Cohort Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S470-S470
Author(s):  
Zachary Most ◽  
Patricia Jackson ◽  
Michael Sebert ◽  
Trish M Perl ◽  
Trish M Perl
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Viral Infections ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Historical Cohort ◽  
Pediatric Hospitals ◽  
Respiratory Viral Infections ◽  
Healthcare Associated

Abstract Background Healthcare-associated respiratory viral infections (HARVI) occur frequently at pediatric hospitals. The spectrum and attributable outcomes of these infections are unknown. Methods Using a matched historical cohort design, HARVI cases identified between July 2013 and June 2018 at a large pediatric referral hospital in Dallas, Texas were defined as patients who tested positive for one of eight respiratory viruses during their hospitalization, had new respiratory symptoms develop during hospitalization, and had symptom onset on a hospitalization day that was greater than the maximum incubation period for the specific respiratory virus. Controls were matched 1:1 for index time, meaning that the control had a hospital length of stay that was at least as long as the length of stay in the matched case prior to viral testing. Controls were also matched for year and month of infection as well as hospital unit and/or age. The primary outcome was additional length of stay following infection or index time. Additional outcomes included transfer to intensive care, need for intubation, hospital charges, and all cause in-hospital mortality. Results Over the 5-year study period, 317 definite HARVI were identified (0.62 per 1,000 admitted patient days), and only 287 (91%) had a matched control to be included in analysis. Among these cases and matched controls, the median time to index time was 19 days (IQR 10-39 days). The most common causative viruses where rhinovirus/enterovirus (188, 65.5%), RSV (30, 10.5%), parainfluenza virus (28, 9.8%), and seasonal coronaviruses (27, 9.4%). Fewer cases than controls were in an intensive care unit at index time (101 [35.2%] vs. 156 [54.4%]) The mean additional length of stay following index time was shorter in cases than controls (35.2 days vs. 48.1 days, difference = -12.9 days, 95% CI -20.95 to -4.82 days). Conclusion Hospital length of stay for cases with HARVI was not longer than for those without HARVI. Possible explanations include confounding and selection bias. Further studies with carefully selected controls are needed. Disclosures All Authors: No reported disclosures

A Collaborative Approach to Improve Consistent Use of Procalcitonin in Lower Respiratory Tract Infections

2018 ◽  
Vol 52 (6) ◽  
pp. 538-545 ◽  
Author(s):  
Alexander R. Levine ◽  
Robyn Riggott ◽  
Kristela Vulaj ◽  
Tera R. Falcetti ◽  
Syed Ali ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Viral Infections ◽  
Intervention Group ◽  
Quality Improvement Initiative ◽  
Lower Respiratory Tract Infections ◽  
Improvement Project ◽  
Tract Infections

Background: Procalcitonin (PCT) is a biomarker that can help differentiate bacterial from viral infections and has been extensively studied in patients with sepsis and pneumonia to guide antibiotic therapy. However, there is poor adherence to prescribed algorithms when used to discontinue antibiotics in the real world. A quality improvement project was implemented to increase consistent use of PCT. Objective: To evaluate use of PCT and impact on antibiotic length of therapy (LOT) preimplementation and postimplementation of a quality improvement initiative. Methods: This was a single-center retrospective cohort study in patients with lower respiratory tract infections (LRTIs). Results: In all, 330 patients were included in this study. Following implementation of the quality improvement initiative, ordering PCT in the first 24 hours increased from 59.6% to 75.5% ( P = 0.011). Documentation to discontinue antibiotics in patients with low initial PCT values increased from 13.2% to 28.6% ( P = 0.100). Increased PCT use correlated with an overall mean reduction of 1.05 antibiotic days between cohorts (6.82 ± 3.88 vs 5.77 ± 3.43, P = 0.028). There was no difference in incidence of antibiotic-associated adverse effects or 30-day hospital readmission rates attributed to pneumonia. Conclusions: Consistent use of PCT was achieved through a collaborative effort with the clinical pharmacy and hospitalist staff. Increased use of PCT was associated with a significant reduction in antibiotic LOT among patients with LRTIs. When controlling for other factors, low initial PCT values had the strongest influence on discontinuing antibiotics within 72 hours in the intervention group.

scholarly journals Reduction in healthcare-associated respiratory viral infections during a COVID-19 outbreak

2020 ◽  
Vol 26 (11) ◽  
pp. 1579-1581 ◽  
Author(s):  
L.E. Wee ◽  
E.P. Conceicao ◽  
X.Y.J. Sim ◽  
K.K.K. Ko ◽  
M.L. Ling ◽  
...  
Keyword(s):  
Viral Infections ◽  
Respiratory Viral Infections ◽  
Healthcare Associated

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

2018 ◽  
Vol 39 (9) ◽  
pp. 1086-1092 ◽  
Author(s):  
Hillary Hei ◽  
Orysia Bezpalko ◽  
Sarah A. Smathers ◽  
Susan E. Coffin ◽  
Julia S. Sammons
Keyword(s):  
Viral Infections ◽  
Respiratory Infections ◽  
Targeted Prevention ◽  
Gastrointestinal Infections ◽  
Statistical Process ◽  
Iterative Development ◽  
Routine Surveillance ◽  
Healthcare Associated ◽  
Pediatric Healthcare ◽  
Infection Preventionists

AbstractObjectiveTo 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.SettingA 546-bed quaternary-care children’s hospital situated in a large urban area.PatientsInpatients 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.MethodsQuality 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.ResultsIn 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%).ConclusionsThe 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.

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