Health Care-Associated Infections Among Critically Ill Children in the US, 2007-2012

Background Critical care nurses take care of patients with complicated, comorbid, and compromised conditions. These patients are at risk for health care–associated infections, which affect patients’ lives and health care systems in various ways. Objective To gauge the impact of routinely bathing patients with 4% chlorhexidine gluconate solution on the incidence of health care–associated infections in a medical-surgical intensive care unit and a postoperative telemetry unit; to outline the framework for a hospital-wide presurgical chlorhexidine gluconate bathing program and share the results. Methods A standard bathing protocol using a 4% chlorhexidine gluconate solution was developed. The protocol included time studies, training, monitoring, and surveillance of health care–associated infections. Results Consistent patient bathing with 4% chlorhexidine gluconate was associated with a 52% reduction in health care–associated infections in a medical-surgical intensive care unit. The same program in a postoperative telemetry unit yielded a 45% reduction in health care–associated infections. Conclusion A comprehensive daily 4% chlorhexidine gluconate bathing program can be implemented with standardized protocols and detailed instructions and can significantly reduce the incidence of health care–associated infections in intensive care unit and non–intensive care unit hospital settings.

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Involving Parents in Decisions to Forego Life-Sustaining Treatment for Critically Ill Infants and Children

AACN Advanced Critical Care ◽

10.4037/15597768-1990-1021 ◽

1990 ◽

Vol 1 (1) ◽

pp. 206-214 ◽

Cited By ~ 5

Author(s):

Cindy Hylton Rushton ◽

Jacqueline J. Glover

Keyword(s):

Health Care ◽

Critically Ill ◽

Communication Networks ◽

Health Care Professionals ◽

Critically Ill Children ◽

Best Interest ◽

Moral Framework ◽

Proper Role ◽

Life Sustaining Treatment ◽

Networks Of Support

A moral framework based on principles of beneficence and respect for persons requires shared decision-making. In the best interest of critically ill children, parents should be the primary decisionmakers in collaboration with health care professionals. When parents are unable to function in their proper role as surrogate, health care professionals must seek an alternative surrogate decisionmaker. A balanced partnership between parents and professionals can be supported by attention to the environmental stressors, enhanced communication, networks of support and institutional mechanisms for conflict resolution.

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Acute Kidney Injury in Critically Ill Children and Subsequent Chronic Kidney Disease

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358119880188 ◽

2019 ◽

Vol 6 ◽

pp. 205435811988018 ◽

Cited By ~ 8

Author(s):

Erin Hessey ◽

Sylvie Perreault ◽

Marc Dorais ◽

Louise Roy ◽

Michael Zappitelli

Keyword(s):

Health Care ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Renal Disease ◽

Critically Ill ◽

Administrative Data ◽

Kidney Injury ◽

Critically Ill Children ◽

Post Discharge

Background: The progression from acute kidney injury (AKI) to chronic kidney disease (CKD) is not well understood in children. Objectives: We aimed to develop a pediatric CKD definition using administrative data and use it to evaluate the association between AKI in critically ill children and CKD 5 years after hospital discharge. Design: Retrospective cohort study using chart collection and administrative data. Setting: Two-center study in Montreal, Canada. Patients: Children (≤18 years old) admitted to two pediatric intensive care units (ICUs) between 2003 and 2005. We a priori excluded patients with end-stage renal disease or no health care number. Only the first admission during the study period was included. We excluded patients who could not be linked to administrative data, did not survive hospitalization, or had preexisting renal disease. Measurements: Acute kidney injury was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients were defined as having CKD 5 years post-discharge if they had ≥1 CKD diagnostic code or ≥1 CKD-specific medication prescription. Methods: Chart data used to define the exposure (AKI) were merged with provincial administrative data used to define the outcome (CKD). Cox regression was used to evaluate the AKI-CKD association. Results: A total of 2235 (56% male) patients were included, and the median admission age was 3.7 years. A total of 464 (21%) patients developed AKI during pediatric ICU admission. At 5 years post-discharge, 43 (2%) patients had a CKD diagnosis. Patients with both stage 1 and stage 2-3 AKI had increased risk of a CKD diagnosis, with the adjusted hazard ratios (95% confidence intervals) of 2.2 (1.1-4.5) and 2.5 (1.1-5.7), respectively ( P < .001). Limitations: Results may not be generalizable to non-ICU patients. We were not able to control for post-discharge variables; future research should try to explore these additional potential risk factors further. Conclusions: Acute kidney injury is associated with 5-year post-discharge CKD diagnosis defined by administrative health care data.

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Health care-associated infections in critically ill premature newborns: epidemiology, clinical features and diagnostics in modern conditions

Neonatology: News, Opinions, Training ◽

10.33029/2308-2402-2020-8-3-7-17 ◽

2020 ◽

Vol 8 (3) ◽

pp. 7-17

Author(s):

Irina V. Nikitina ◽

◽

Anastasiya V. Gerasimova ◽

Lyubov A. Ivanova ◽

Olga A. Krogh-Jensen ◽

...

Keyword(s):

Health Care ◽

Critically Ill ◽

Clinical Features ◽

Premature Newborns ◽

Health Care Associated Infections

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An International Survey Comparing Different Physician Models for Health Care Delivery to Critically Ill Children With Heart Disease

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000002268 ◽

2020 ◽

Vol 21 (5) ◽

pp. 415-422

Author(s):

Priya Bhaskar ◽

Mallikarjuna Rettiganti ◽

Efraim Sadot ◽

Thomas Paul ◽

Daniel Garros ◽

...

Keyword(s):

Health Care ◽

Heart Disease ◽

Critically Ill ◽

Health Care Delivery ◽

Care Delivery ◽

Critically Ill Children ◽

International Survey

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Faculty Opinions recommendation of Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726065772.793513062 ◽

2016 ◽

Author(s):

Edward J Septimus

Keyword(s):

Health Care ◽

Health Care System ◽

Meta Analysis ◽

Financial Impact ◽

The Us ◽

Health Care Associated Infections ◽

Care System

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332 The Reliability of Sick Children Require Evaluation Now to Prioritize Critically Ill Children in Primary Health Care Centers in Low-Resource Settings

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2014.07.360 ◽

2014 ◽

Vol 64 (4) ◽

pp. S117

Author(s):

B. Hansoti ◽

A. Jenson ◽

R.E. Rothman ◽

T. Kirsch ◽

L. Wallis

Keyword(s):

Health Care ◽

Primary Health Care ◽

Critically Ill ◽

Critically Ill Children ◽

Low Resource Settings ◽

Low Resource ◽

Primary Health ◽

Sick Children ◽

Primary Health Care Centers ◽

Health Care Centers

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Paediatric health care access in community health centres is associated with survival for critically ill children who undergo inter-facility transport: A province-wide observational study

Paediatrics & Child Health ◽

10.1093/pch/pxz013 ◽

2019 ◽

Vol 25 (5) ◽

pp. 308-316 ◽

Cited By ~ 1

Author(s):

Janice A Tijssen ◽

Teresa To ◽

Laurie J Morrison ◽

Fuad Alnaji ◽

Russell D MacDonald ◽

...

Keyword(s):

Health Care ◽

Critically Ill ◽

Acute Care ◽

Health Care Access ◽

Health Care Services ◽

Critically Ill Children ◽

Care Access ◽

Care Services ◽

Lengths Of Stay ◽

Services Use

Abstract Background Diverse settlement makes inter-facility transport of critically ill children a necessary part of regionalized health care. There are few studies of outcomes and health care services use of this growing population. Methods A retrospective study evaluated the frequency of transports, health care services use, and outcomes of all critically ill children who underwent inter-facility transport to a paediatric intensive care unit (PICU) in Ontario from 2004 to 2012. The primary outcome was PICU mortality. Secondary outcomes were 24-hour and 6-month mortality, PICU and hospital lengths of stay, and use of therapies in the PICU. Results The 4,074 inter-facility transports were for children aged median (IQR) 1.6 (0.1 to 8.3) years. The rate of transports increased from 15 to 23 per 100,000 children. There were 233 (5.7%) deaths in PICU and an additional 78 deaths (1.9%) by 6 months. Length of stay was median (IQR) 2 (1 to 5) days in PICU and 7 (3 to 14) days in the receiving hospital. Lower PICU mortality was independently associated with prior acute care contact (odds ratio [OR]=0.3, 95% confidence interval [CI]: 0.2 to 0.6) and availability of paediatric expertise at the referral hospital (OR=0.7, 95% CI: 0.5 to 1.0). Conclusions We found that in Ontario, children undergoing inter-facility transport to PICUs are increasing in number, consume significant acute care resources, and have a high PICU mortality. Access to paediatric expertise is a potentially modifiable factor that can impact mortality and warrants further evaluation.

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