American Journal of Infection Control 42 (2014) 1233-4
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Brief report
Infection prevention and control practices in pediatric long-term care facilities Meghan T. Murray MPH a, Bevin Cohen MPH a, Natalie Neu MD, MPH b, c, Gordon Hutcheon MD c, Edwin Simpser MD d, Elaine Larson RN, PhD a, Lisa Saiman MD, MPH b, e, * a
School of Nursing, Columbia University Medical Center, New York, NY Department of Pediatrics, Columbia University Medical Center, New York, NY Elizabeth Seton Pediatric Center, Yonkers, NY d St. Mary’s Hospital for Children, Bayside, NY e Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, NY b c
Key Words: Pediatrics Long-term care Practice guidelines
Pediatric long-term care facilities (pLTCFs) provide for children with chronic, complex medical needs and therefore face unique challenges for infection prevention and control (IP&C). At a conference in 2012, pLTCF providers reported IP&C issues of greatest concern in a survey. Major concerns included the lack of IP&C best practice guidelines, multidrug-resistant bacteria, and viral respiratory infections. Best practice guidelines for IP&C specific to pLTCF populations should be developed and evaluated. Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Pediatric long-term care facilities (LTCFs) are defined as longterm care, subacute, or rehabilitation facilities that provide care for medically complex children with special care needs.1 Advances in neonatal care and life-saving interventions for congenital conditions and acute trauma have increased survival rates, but they have led to a growing population of infants, children, adolescents, and young adults who require high levels of clinical support.2 Such support includes indwelling devices (eg, gastrostomy tubes, tracheostomies, urinary tract catheters, central venous catheters). In addition, residents in pediatric LTCFs benefit from numerous therapeutic and social activities, which require large amounts of equipment and result in frequent interactions with each other, health care personnel, nonmedical staff, volunteers, and visitors. Prevention of health careeassociated infections is a priority for all LTCFs, but pediatric LTCFs face unique challenges because of the population’s complex medical care needs; age-related vulnerability to infections, particularly viral infections; and extensive
* Address correspondence to Lisa Saiman, MD, MPH, Columbia University Medical Center, 622 W 168th St, PH 4, West Room 470, New York, NY 10032. E-mail address: [email protected] (L. Saiman). To assure the integrity of our review process, the blinded peer review and final decision regarding publication for any manuscript on which the AJIC editor or an associate editor is an author is handled independently; that editor/associate editor has no decision making role in such manuscripts. Conflict of interest: None to report.
interactions that occur with others. The aim of this study was to identify infection prevention and control (IP&C) issues of greatest concern to health care providers caring for children in pediatric LTCFs. METHODS Participants from 21 pediatric LTCFs in the United States attending the national Enhancing the Care of the Child Who is Medically Complex Conference in October 2012 were asked to complete an anonymous survey on IP&C practices, policies, and concerns at their facility. Data regarding the size, staffing, and indwelling device use were also collected. The 28-item survey took approximately 15 minutes to complete and included multiple choice and free response questions. The Columbia University Medical Center Institutional Review Board approved this research as part of Keep It Clean for Kids (Agency for Healthcare Research and Quality, R01 HS021470). RESULTS Forty-one respondents (19 chief medical, operating, or workforce health/safety officers; 16 nurses; 2 physicians; 2 infection preventionists; 2 who did not identify their position) of 123 (33%) attendees completed the survey. The number of pediatric beds at
0196-6553/$36.00 - Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2014.07.026
1234
M.T. Murray et al. / American Journal of Infection Control 42 (2014) 1233-4
Table 1 Infection prevention and control issues of greatest concern in pediatric long-term care facilities
Issue Multidrug-resistant bacteria in residents Viral respiratory infections in residents Ill visitors coming to facility Staff working while ill Shared equipment by residents Resident crowding Gastrointestinal infections Limited availability of diagnostic testing for infections Low rates of influenza among staff
Rated extremely important, n (%) 31 27 25 21 20 19 17 15 12
(76) (66) (61) (51) (49) (46) (41) (37) (29)
the respondents’ facilities ranged from 16-130. Most reported use of central venous catheters (54%), ventilators (56%), tracheostomies (85%), and gastrostomy tubes (95%). Most (71%) reported that their facility had infection preventionists, and hand hygiene observations were performed (59%). Most respondents reported that their facilities lacked IP&C practice guidelines for visitors and staff (85%), respiratory infections (85%), gastroenteritis (80%), and staff vaccination policies (78%). IP&C issues of greatest concern to respondents are described in Table 1. CONCLUSIONS To our knowledge, this is the first survey that identifies IP&C practices and concerns among health care personnel in pediatric LTCFs. Respondents reported the need for several practice guidelines for IP&C and identified infections caused by multidrugresistant bacteria and viral respiratory pathogens as their greatest IP&C concerns. Although there are numerous IP&C guidelines for acute care focused on prevention of device-related infections, surgical site infections, and management of multidrug-resistant
bacteria, these are likely to be of limited applicability for pediatric LTCFs.3 To our knowledge, although colonization of drug-resistant bacteria has been reported in this population,4,5 there have been no systematic assessments of their burden or impact on the residents of pediatric LTCFs. Outbreaks of respiratory viruses have been well described and associated with substantial morbidity and mortality and the need for transfer to acute care.6,7 However, there are no data about endemic respiratory infections in pediatric LTCFs, in part because testing for viral pathogens is not usually performed in such facilities. This current study was limited by the small number of respondents and the fact that potentially >1 respondent from the same site completed the survey. In conclusion, this study underscores the need for best practice guidelines for IP&C specific to this unique pediatric population and the need to study the effectiveness of such practices. References 1. McPherson M, Arango P, Fox H, Lauver C, McManus M, Newacheck PW, et al. A new definition of children with special health care needs. Pediatrics 1998;102: 137-40. 2. Cohen E, Kuo DZ, Agrawal R, Berry JG, Bhagat SK, Simon TD, et al. Children with medical complexity: an emerging population for clinical and research initiatives. Pediatrics 2011;127:529-38. 3. Harris JA. Infection control in pediatric extended care facilities. Infect Control Hosp Epidemiol 2006;27:598-603. 4. Lidsky K, Hoyen C, Salvator A, Rice LB, Toltzis P. Antibiotic-resistant gramnegative organisms in pediatric chronic-care facilities. Clin Infect Dis 2002;34: 760-6. 5. Viau RA, Hujer AM, Marshall SH, Perez F, Hujer KM, Briceño DF, et al. “Silent” dissemination of Klebsiella pneumoniae isolates bearing K. pneumoniae carbapenemase in a long-term care facility for children and young adults in Northeast Ohio. Clin Infect Dis 2012;54:1314-21. 6. Neu N, Plaskett T, Hutcheon G, Murray M, Southwick KL, Saiman L. Epidemiology of human metapneumovirus in a pediatric long-term care facility. Infect Control Hosp Epidemiol 2012;33:545-50. 7. Centers for Disease Control and Prevention (CDC). Severe influenza among children and young adults with neurologic and neurodevelopmental conditions Ohio, 2011. MMWR Morb Mortal Wkly Rep 2012;60:1729-33.
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Brief report
Infection prevention and control practices in pediatric long-term care facilities Meghan T. Murray MPH a, Bevin Cohen MPH a, Natalie Neu MD, MPH b, c, Gordon Hutcheon MD c, Edwin Simpser MD d, Elaine Larson RN, PhD a, Lisa Saiman MD, MPH b, e, * a
School of Nursing, Columbia University Medical Center, New York, NY Department of Pediatrics, Columbia University Medical Center, New York, NY Elizabeth Seton Pediatric Center, Yonkers, NY d St. Mary’s Hospital for Children, Bayside, NY e Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, NY b c
Key Words: Pediatrics Long-term care Practice guidelines
Pediatric long-term care facilities (pLTCFs) provide for children with chronic, complex medical needs and therefore face unique challenges for infection prevention and control (IP&C). At a conference in 2012, pLTCF providers reported IP&C issues of greatest concern in a survey. Major concerns included the lack of IP&C best practice guidelines, multidrug-resistant bacteria, and viral respiratory infections. Best practice guidelines for IP&C specific to pLTCF populations should be developed and evaluated. Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Pediatric long-term care facilities (LTCFs) are defined as longterm care, subacute, or rehabilitation facilities that provide care for medically complex children with special care needs.1 Advances in neonatal care and life-saving interventions for congenital conditions and acute trauma have increased survival rates, but they have led to a growing population of infants, children, adolescents, and young adults who require high levels of clinical support.2 Such support includes indwelling devices (eg, gastrostomy tubes, tracheostomies, urinary tract catheters, central venous catheters). In addition, residents in pediatric LTCFs benefit from numerous therapeutic and social activities, which require large amounts of equipment and result in frequent interactions with each other, health care personnel, nonmedical staff, volunteers, and visitors. Prevention of health careeassociated infections is a priority for all LTCFs, but pediatric LTCFs face unique challenges because of the population’s complex medical care needs; age-related vulnerability to infections, particularly viral infections; and extensive
* Address correspondence to Lisa Saiman, MD, MPH, Columbia University Medical Center, 622 W 168th St, PH 4, West Room 470, New York, NY 10032. E-mail address: [email protected] (L. Saiman). To assure the integrity of our review process, the blinded peer review and final decision regarding publication for any manuscript on which the AJIC editor or an associate editor is an author is handled independently; that editor/associate editor has no decision making role in such manuscripts. Conflict of interest: None to report.
interactions that occur with others. The aim of this study was to identify infection prevention and control (IP&C) issues of greatest concern to health care providers caring for children in pediatric LTCFs. METHODS Participants from 21 pediatric LTCFs in the United States attending the national Enhancing the Care of the Child Who is Medically Complex Conference in October 2012 were asked to complete an anonymous survey on IP&C practices, policies, and concerns at their facility. Data regarding the size, staffing, and indwelling device use were also collected. The 28-item survey took approximately 15 minutes to complete and included multiple choice and free response questions. The Columbia University Medical Center Institutional Review Board approved this research as part of Keep It Clean for Kids (Agency for Healthcare Research and Quality, R01 HS021470). RESULTS Forty-one respondents (19 chief medical, operating, or workforce health/safety officers; 16 nurses; 2 physicians; 2 infection preventionists; 2 who did not identify their position) of 123 (33%) attendees completed the survey. The number of pediatric beds at
0196-6553/$36.00 - Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2014.07.026
1234
M.T. Murray et al. / American Journal of Infection Control 42 (2014) 1233-4
Table 1 Infection prevention and control issues of greatest concern in pediatric long-term care facilities
Issue Multidrug-resistant bacteria in residents Viral respiratory infections in residents Ill visitors coming to facility Staff working while ill Shared equipment by residents Resident crowding Gastrointestinal infections Limited availability of diagnostic testing for infections Low rates of influenza among staff
Rated extremely important, n (%) 31 27 25 21 20 19 17 15 12
(76) (66) (61) (51) (49) (46) (41) (37) (29)
the respondents’ facilities ranged from 16-130. Most reported use of central venous catheters (54%), ventilators (56%), tracheostomies (85%), and gastrostomy tubes (95%). Most (71%) reported that their facility had infection preventionists, and hand hygiene observations were performed (59%). Most respondents reported that their facilities lacked IP&C practice guidelines for visitors and staff (85%), respiratory infections (85%), gastroenteritis (80%), and staff vaccination policies (78%). IP&C issues of greatest concern to respondents are described in Table 1. CONCLUSIONS To our knowledge, this is the first survey that identifies IP&C practices and concerns among health care personnel in pediatric LTCFs. Respondents reported the need for several practice guidelines for IP&C and identified infections caused by multidrugresistant bacteria and viral respiratory pathogens as their greatest IP&C concerns. Although there are numerous IP&C guidelines for acute care focused on prevention of device-related infections, surgical site infections, and management of multidrug-resistant
bacteria, these are likely to be of limited applicability for pediatric LTCFs.3 To our knowledge, although colonization of drug-resistant bacteria has been reported in this population,4,5 there have been no systematic assessments of their burden or impact on the residents of pediatric LTCFs. Outbreaks of respiratory viruses have been well described and associated with substantial morbidity and mortality and the need for transfer to acute care.6,7 However, there are no data about endemic respiratory infections in pediatric LTCFs, in part because testing for viral pathogens is not usually performed in such facilities. This current study was limited by the small number of respondents and the fact that potentially >1 respondent from the same site completed the survey. In conclusion, this study underscores the need for best practice guidelines for IP&C specific to this unique pediatric population and the need to study the effectiveness of such practices. References 1. McPherson M, Arango P, Fox H, Lauver C, McManus M, Newacheck PW, et al. A new definition of children with special health care needs. Pediatrics 1998;102: 137-40. 2. Cohen E, Kuo DZ, Agrawal R, Berry JG, Bhagat SK, Simon TD, et al. Children with medical complexity: an emerging population for clinical and research initiatives. Pediatrics 2011;127:529-38. 3. Harris JA. Infection control in pediatric extended care facilities. Infect Control Hosp Epidemiol 2006;27:598-603. 4. Lidsky K, Hoyen C, Salvator A, Rice LB, Toltzis P. Antibiotic-resistant gramnegative organisms in pediatric chronic-care facilities. Clin Infect Dis 2002;34: 760-6. 5. Viau RA, Hujer AM, Marshall SH, Perez F, Hujer KM, Briceño DF, et al. “Silent” dissemination of Klebsiella pneumoniae isolates bearing K. pneumoniae carbapenemase in a long-term care facility for children and young adults in Northeast Ohio. Clin Infect Dis 2012;54:1314-21. 6. Neu N, Plaskett T, Hutcheon G, Murray M, Southwick KL, Saiman L. Epidemiology of human metapneumovirus in a pediatric long-term care facility. Infect Control Hosp Epidemiol 2012;33:545-50. 7. Centers for Disease Control and Prevention (CDC). Severe influenza among children and young adults with neurologic and neurodevelopmental conditions Ohio, 2011. MMWR Morb Mortal Wkly Rep 2012;60:1729-33.
