Among children with acute respiratory tract infections, broad-spectrum antibiotics were not associated with better clinical or patient-centered outcomes compared with narrow-spectrum antibiotics, and were associated with higher rates of adverse events. These data support the use of narrow-spectrum antibiotics for most children with acute respiratory tract infections.
We identified barriers to communication with families both within and between teams and for individual physicians. Formal communication training and processes that standardize communication to ensure completeness and role delineation between clinical teams may improve oncologists' and intensivists' ability to initiate GCDs, thereby fulfilling their ethical obligations of decision support.
Background
Healthcare-associated viral infections (HA-VIs) are common in hospitalized children and are increasingly recognized as a cause of preventable harm; however, the epidemiology and modifiable risk factors for pediatric HA-VIs are poorly understood.
Methods
We performed a retrospective case-control study to identify risk factors and outcomes associated with pediatric HA-VIs at a quaternary care children’s hospital. HA-VI surveillance was performed hospital-wide using Centers for Disease Control and Prevention (CDC) definitions. We abstracted data from the electronic medical record and conducted semi-structured interviews with patient caregivers to identify potential exposures 4 days before the HA-VI onset.
Results
During the 20-month study period, we identified 143 eligible patients with HA-VIs and enrolled 64 matched case-control pairs. In total, 79 viruses were identified among 64 case patients. During the exposure period, case, as compared with control, patients were more frequently exposed to a sick visitor (odds ratio = 5.19; P = .05). During the 7 days after the HA-VI onset, case, as compared with control, patients had a greater length of antibacterial therapy per patient-days (mean 411 vs 159) as well as greater days of antibacterial therapy per patient-days (mean 665 vs 247).
Conclusions
The results of this study show that exposure to a sick visitor is a potentially modifiable risk factor for pediatric HA-VIs. Hospitalized children with HA-VIs also have increased exposure to antibacterial agents when compared with matched controls. Our findings suggest that hospital policies may need to be revised, with emphasis on visitor screening and partnership with families, to reduce the incidence of pediatric HA-VIs during hospitalization.
Compared to chart review, a definition based on the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for healthcare-associated influenza-like illness (HA-ILI) among young children in a large pediatric network demonstrated high positive and negative predictive values. This finding suggests that electronic health record-based definitions for surveillance can accurately identify medically attended outpatient HA-ILI cases for research and surveillance. Infect Control Hosp Epidemiol 2016;1-4.
BackgroundMost pediatric healthcare encounters for influenza-like-illness (ILI) take place in ambulatory settings where there may be multiple opportunities for transmission of respiratory viruses, yet adherence to recommended respiratory etiquette behaviors is inconsistent. We developed brief family education videos and evaluated their impact on knowledge about respiratory virus transmission and IPC practices and intention to use respiratory etiquette behaviors.MethodsWe developed 3 animated, 2–3 minute videos for waiting room display. Content included respiratory virus transmission and the use of hand hygiene, masks, and tissues in a Cover Your Cough Station (CYCS). A convenience sample of caregivers (N = 116) recruited from waiting rooms of two primary care clinics in a large pediatric care network completed a questionnaire measuring perceptions of respiratory virus transmission risk in clinics and knowledge about IPC strategies before and after viewing the videos. Clinical staff (N = 8) from participating clinics revaluated content and clarity of each video using an adapted version of The Patient Education Materials Assessment Tool (PEMAT).ResultsAfter viewing all videos, a significantly higher proportion of respondents knew where to find a CYCS (59%, 93%, P < 0.0001), accurately named CYCS items (30%, 72%, P < 0.0001), identified why cough etiquette is important (65% vs. 83%, P = 0.0003) and would use CYCS during office visits (61% vs. 89%, P = 0.0001). Baseline knowledge about appropriate hand hygiene and cough etiquette practices was high with no significant change post-video. Most caregivers reported that our videos were easy to understand (90%, 79%, and 82% for videos 1–3, respectively) and that the videos made them want to use a CYCS (95%, 91%, 85% for videos 1–3.). All clinical staff agreed that the videos were appropriate for parents and children and also align with the practices’ IPC policies and other healthcare messages received by clinical staffConclusionTargeted educational videos may be an effective method for increasing awareness of respiratory etiquette resources in pediatric clinics to encourage the use of IPC strategies and prevent the spread of respiratory viruses.Disclosures
All authors: No reported disclosures.
BackgroundExisting Centers for Disease Control (CDC) and American Academy of Pediatrics (AAP) guidelines promote HCW personal protective equipment (PPE) use to prevent respiratory virus transmission in pediatric clinics; however, adherence to recommendations is inconsistent. We evaluated the effectiveness of two strategies designed to cue HCW use of PPE in a pediatric primary care clinic.MethodsWe implemented two HCW-focused interventions: (1) prompt for front desk respiratory symptom screen with placement of droplet signs on examination room door for symptomatic patients and (2) universal masking of healthcare workers during all patient encounters. Each intervention was implemented over a 2-week period and preceded by a washout period. We obtained caregiver report of HCW hand hygiene and mask use during patient encounters and measured differences in the proportion of behavior observed compared with washout periods.ResultsWe obtained 217 caregiver reports of clinician handwashing and mask use before, during and after the patient encounter. There was no difference in nurse pre- or post-encounter hand hygiene behavior before and after each intervention (Baseline 65.9%; Droplet: 73.3%, P = 0.34; Universal masking: 77.5%, P = 0.16 and Baseline 53.3%; Droplet: 66.6%, P = 0.14; Universal masking: 55%, P = 0.85, respectively). There was also no difference in pre- or post-encounter MD hand hygiene behavior before and after each intervention: (Baseline 86.9%; Droplet: 77.8, P = 0.17; Universal masking: 87.5%; P = 0.92 and Baseline 75%; Droplet: 71.1%, P = 0.62; Universal masking: 80.0%; P = 0.53, respectively). However, there was a significant difference in observed mask use during encounters among both RNs and MDs before and after each intervention: (Baseline: 17.4%; Droplet: 44.4%, P <0.05; Universal masking: 42.5%, P < 0.05 and Baseline: 20.6%; Droplet: 51.1%, P < 0.05; Universal masking: 62.5%, P < 0.05, respectively).ConclusionRespiratory symptom screening with visual prompts to use PPE and universal masking may not significantly impact hand hygiene behavior in a setting with high hand hygiene use but may increase mask use. Such interventions could provide a useful and low cost tool to help prevent the spread of respiratory viruses in primary care settings.Disclosures
S. E. Coffin, Merck, Inc.: Investigator, Research support.
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