Health care–associated infection outbreaks in pediatric long-term care facilities

Murray, Meghan; Pavia, Marianne; Jackson, Olivia; Keenan, Mary; Neu, Natalie; Cohen, Bevin; Saiman, Lisa; Larson, Elaine

doi:10.1016/j.ajic.2015.03.010

Cited by 10 publications

(15 citation statements)

References 9 publications

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“…For this study, outbreaks of acute respiratory infections were defined as ≥ 2 cases of the same laboratory-confirmed pathogen or ≥ 2 cases on the same unit with the same symptoms. 32…”

Section: Rates Of Infections and Hospitalizations-ongoing Medical Recmentioning

confidence: 99%

Behavioral Interventions to Reduce Infections in Pediatric Long-term Care Facilities: The Keep It Clean for Kids Trial

Larson

Murray

Cohen

et al. 2017

Behavioral Medicine

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Children in pediatric long-term care facilities (pLTCF) represent a highly vulnerable population and infectious outbreaks occur frequently, resulting in significant morbidity, mortality, and resource use. The purpose of this quasi-experimental trial using time series analysis was to assess the impact of a 4-year theoretically based behavioral intervention on infection prevention practices and clinical outcomes in three pLTCF (288 beds) in New York metropolitan area including 720 residents, ages 1 day to 26 years with mean lengths of stay: 7.9-33.6 months. The 5-pronged behavioral intervention included explicit leadership commitment, active staff participation, work flow assessments, training staff in the World Health Organization "'five moments of hand hygiene (HH)," and electronic monitoring and feedback of HH frequency. Major outcomes were HH frequency, rates of infections, number of hospitalizations associated with infections, and outbreaks. Mean infection rates/1000 patient days ranged from 4.1-10.4 pre-intervention and 2.9-10.0 post-intervention. Mean hospitalizations/1000 patient days ranged from 2.3-9.7 before and 6.4-9.8 after intervention. Number of outbreaks/1000 patient days per study site ranged from 9-24 pre- and 9-18 post-intervention (total = 95); number of cases/outbreak ranged from 97-324 (total cases pre-intervention = 591 and post-intervention = 401). Post-intervention, statistically significant increases in HH trends occurred in one of three sites, reductions in infections in two sites, fewer hospitalizations in all sites, and significant but varied changes in the numbers of outbreaks and cases/outbreak. Modest but inconsistent improvements occurred in clinically relevant outcomes. Sustainable improvements in infection prevention in pLTCF will require culture change; increased staff involvement; explicit administrative support; and meaningful, timely behavioral feedback.

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“…For this study, outbreaks of acute respiratory infections were defined as ≥ 2 cases of the same laboratory-confirmed pathogen or ≥ 2 cases on the same unit with the same symptoms. 32…”

Section: Rates Of Infections and Hospitalizations-ongoing Medical Recmentioning

confidence: 99%

Behavioral Interventions to Reduce Infections in Pediatric Long-term Care Facilities: The Keep It Clean for Kids Trial

Larson

Murray

Cohen

et al. 2017

Behavioral Medicine

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“…3 Cases were considered part of an outbreak if they occurred within the maximum incubation period of the pathogen defined by Red Book. 5 …”

Section: Data Collectionmentioning

confidence: 99%

Impact of Infection Prevention and Control Initiatives on Acute Respiratory Infections in a Pediatric Long-Term Care Facility

Murray

Jackson²,

Cohen

et al. 2016

Infect. Control Hosp. Epidemiol.

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We evaluated the collective impact of several infection prevention and control initiatives aimed at reducing acute respiratory infections (ARIs) in a pediatric long-term care facility. ARIs did not decrease overall, though the proportion of infections associated with outbreaks and average number of cases per outbreak decreased. Influenza rates decreased significantly.Acute respiratory infections (ARIs) are burdensome in pediatric long-term care facilities (pLTCFs). Infection prevention and control (IP&C) interventions such as hand hygiene improvement, hiring IP&C personnel experienced in long-term care, prophylactic administration of oseltamivir, and staff and resident influenza vaccination have reduced outbreaks in adult long-term care. 1 However, pLTCFs present additional challenges due to the family-centered approach, on-site schools, age-related vulnerability to infections, high rate of device utilization, and behavioral factors that increase transmission (eg, uncontrolled secretions). 2 Outbreaks in pLTCFs lead not only to morbidity and acute care hospitalizations for infected children but also to school closures and service reductions that affect quality of life for all residents. 3 Thus, preventing ARIs and limiting outbreaks are uniquely important in these settings. In this study, we implemented several IP&C interventions aimed at reducing ARIs in a pLTCF, and we compared the incidence of ARIs and related outcomes before and after implementation.Address correspondence to Meghan T. Murray, MPH, 617 West 168th Street, Room 355, New York, NY 10032 (mtm2164@cumc.columbia.edu). Potential conflicts of interest: All authors report no conflicts of interest relevant to this article. HHS Public Access METHODS Study PopulationThis study was conducted from January 2009 through May 2015 at a 137-bed pLTCF in New York that provides subacute, long-term, and rehabilitative services (bed occupancy, 97%-100%). The mean age of residents was 9.7 years (range, 2 months-21 years), and the average length of stay was 477 days (range, 1-7,315 days). Residents were being treated with mechanical ventilation (6%), tracheostomies (36%), and gastrostomy tubes (80%). Most residents had neurological deficits (>90%) including cerebral palsy, brain anomalies, and/or hypoxic ischemic encephalopathy. Most residents (83%) attended an on-site Department of Education school, and a few residents (4%) attended schools in the community. The staff-to-resident ratio was 4:1 and included 7 onsite clinicians. This study was approved by the appropriate institutional review boards. Infection Prevention and Control PoliciesA single IP&C coordinator worked with medicine, nursing, and environmental services to conduct active surveillance and to develop IP&C policies. Resident influenza vaccination and ARI isolation policies remained consistent throughout the study. All residents without a contraindication (>95%) were vaccinated for influenza. Residents with ARIs (index cases) were placed on contact/droplet precautions until 48 hours after sympto...

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“…Several outbreaks, particularly of viral upper respiratory infections, have been reported in pLTCFs across the country (James et al, 2007; Kopel et al, 2010). Between January 2010 and December 2013 in the three pLTCFs included in this current study, we identified 62 outbreaks involving 700 cases in residents and 250 cases in staff (Murray et al, 2015). Furthermore, we conducted a survey at the 2013 Pediatric Complex Care Association Annual National Conference in which pLTCF providers reported infection prevention and control issues of greatest concern in a survey, including the lack of best practice guidelines, multidrug-resistant bacteria, and viral respiratory infections (Murray et al, 2014).…”

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confidence: 99%

Staff Knowledge, Awareness, Perceptions, and Beliefs About Infection Prevention in Pediatric Long-term Care Facilities

Løyland

Wilmont

Hessels³

et al. 2016

Nursing Research

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Background The burden of healthcare-associated infection worldwide is considerable, and there is a need to improve surveillance and infection control practices such as hand hygiene. Objectives The aims of this study were to explore direct care providers’ knowledge about infection prevention and hand hygiene, their attitudes regarding their own and others’ hand hygiene practices, and their ideas and advice for improving infection prevention efforts. Methods This exploratory study included interviews with direct care providers in three pediatric long-term care facilities. Two trained nurse interviewers conducted semistructured interviews using an interview guide with open-ended questions. Two other nurse researchers independently transcribed the audio recordings and conducted a thematic analysis using a strategy adapted from the systematic text condensation approach. Results From 31 interviews, four major thematic categories with subthemes emerged from the analysis: (a) hand hygiene products; (b) knowledge, awareness, perceptions, and beliefs; (c) barriers to infection prevention practices; and (d) suggested improvements. There was confusion regarding hand hygiene recommendations, use of soap or sanitizer, and isolation precaution policies. There was a robust “us” and “them” mentality between professionals. Discussion One essential driver of staff behavior change is having expectations that are meaningful to staff, and many staff members stated that they wanted more in-person staff meetings with education and hands-on, practical advice. Workflow patterns and/or the physical environment need to be carefully evaluated to identify systems and methods to minimize cross-contamination. Further studies need to evaluate if personal sized containers of hand sanitizer (e.g., for the pocket, attached to a belt or lanyard) would facilitate improvement of hand hygiene in these facilities.

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Health care–associated infection outbreaks in pediatric long-term care facilities

Cited by 10 publications

References 9 publications

Behavioral Interventions to Reduce Infections in Pediatric Long-term Care Facilities: The Keep It Clean for Kids Trial

Behavioral Interventions to Reduce Infections in Pediatric Long-term Care Facilities: The Keep It Clean for Kids Trial

Impact of Infection Prevention and Control Initiatives on Acute Respiratory Infections in a Pediatric Long-Term Care Facility

Staff Knowledge, Awareness, Perceptions, and Beliefs About Infection Prevention in Pediatric Long-term Care Facilities

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