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New prevention bundle significantly reduces pediatric health care-associated viral infections
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Pediatric health care-associated viral infections, or HAVIs, were significantly reduced by the development, implementation and refinement of targeted prevention practices, according to findings published in Infection Control & Hospital Epidemiology.
“The application of standard prevention bundles has proven successful in the reduction of other health care-associated infections, such as central line-associated bloodstream infections or catheter-associated urinary tract infections, but the application of a comprehensive bundle to prevent HAVI has not been previously described,” Julia Sammons, MD, MSCE, hospital epidemiologist and medical director of the department of infection prevention and control at Children's Hospital of Philadelphia (CHOP), told Infectious Diseases in Children.
HAVIs are difficult to prevent, especially in the pediatric setting, due to frequent visitors, hospital playrooms and shared toys. To reduce HAVI rates to 0.70 infections or fewer per 1,000 patient-days, infection preventionists at CHOP underwent a multiyear quality improvement initiative between 2010 and 2015.
CHOP implemented a hand hygiene program to increase compliance to hand washing practices. In response to the higher burden of community symptomatic and asymptomatic viral illnesses during the winter months, CHOP also developed a visitation procedure which limited visitation to healthy siblings plus four healthy adults per admitted patient. To protect patients and minimize pathogen transmission risk from sick visitors, CHOP’s department of infection prevention and control created a scripted questionnaire as an acute illness screening intervention for visitors. Healthy visitors received stickers to indicate their status, and visitors who reported symptoms of a viral illness were told to return when symptoms cleared. A beside review process was also implemented to identify potential causes of infection and target improvement areas. Furthermore, environmental cleanliness was monitored through regular quality control checks of high-touch areas with adenosine triphosphate testing, and patients with a prolonged stay of more than 14 days had their rooms were cleaned every 2 weeks as though they had been discharged. To address the prevalence of physicians and advanced practice providers who work while sick, the hospital developed acute illness guidelines that specified a liaison per division to find coverage for sick employees and removed penalties for less than 2 days of absence due to illness. The department of infection prevention and control became responsible for the collection of the audit data of personal protective equipment to increase reliability.
Finally, CHOP centralized its harm prevention efforts under a global Harm Prevention Program, which included HAVI protection, in 2015. The standard prevention bundles were formalized across the hospital, and the specific set of best practices in place for HAVI prevention were officially codified as a “HAVI Prevention Bundle” in July 2015.
Sammons and colleagues reviewed HAVI data from July 2012 through June 2016 and 436 HAVIs were identified during the quality improvement initiative. They observed that upper respiratory infections comprised 63% of HAVIs. Additionally, 34% were gastrointestinal infections and 2.5% were viral pneumonias. Rhinovirus (n = 171) and norovirus (n = 83) were the most common pathogens, according to the study. Sammons and colleagues reported that in 15% of documented HAVIs, patients had contact with a sick primary caregiver and 15% reported contact with a sick visitor. HAVI event reviews conducted by Sammons and colleagues revealed that within 4 days before illness onset, a sick health care worker performed care in 9% of infection events.
In March 2014, Sammons and colleagues observed a statistically significant reduction in the rate of HAVIs. The monthly average declined from 0.81 to 0.60 infections per 1,000 patient days, surpassing the initial goal. Hand hygiene (P =.001) and visitor screening (P <.001) also increased, according to the study. Care escalation occurred in 37% of patients, 11% were transferred to the ICU and 19% experienced a delayed discharge.
The implementation and refinement of targeted prevention practices significantly reduced HAVI events at CHOP. The researchers suggest that this HAVI bundle could help to improve ongoing efforts to reduce pediatric viral infections.
“Successful HAVI prevention requires both systems and patient-level interventions and engagement from a multidisciplinary care team,” Sammons said. “HAVI prevention can be challenging, but the application of a comprehensive prevention bundle can lead to significant improvement.” – By Marley Ghizzone
Disclosures: Sammons reports receiving support through a CDC Cooperative Agreement (FOA#CK16-004) with the Epicenters for the Prevention of Healthcare-associated Infections.
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