Hand Hygiene Opportunities in Pediatric Extended Care Facilities

Buet, Amanda; Cohen, Bevin; Marine, Melissa; Scully, Fiona; Alper, Paul; Simpser, Edwin; Saiman, Lisa; Larson, Elaine

doi:10.1016/j.ajic.2012.04.140

Cited by 4 publications

(7 citation statements)

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“…21 In pLTCFs, there are numerous opportunities for exposure to and transmission of potential pathogens, particularly respiratory viruses. 10,11,22 Residents require numerous medical interventions, specialized equipment, and rehabilitative and recreational services provided by staff with specialized skills. 12,22 The facilities' physical structure may also contribute to pathogen transmission because of multibed resident bedrooms, common eating areas, and on-site schools.…”

Section: Discussionmentioning

confidence: 99%

“…10,11,22 Residents require numerous medical interventions, specialized equipment, and rehabilitative and recreational services provided by staff with specialized skills. 12,22 The facilities' physical structure may also contribute to pathogen transmission because of multibed resident bedrooms, common eating areas, and on-site schools. Furthermore, social and physical interactions are valued; thus, residents are in close contact with other residents, staff, volunteers, and visitors of all ages.…”

Section: Discussionmentioning

confidence: 99%

“…Device use is associated with increased contact with staff and therefore an increased risk of transmission of pathogens. 22,24 Feeding tubes could increase the risk of aspiration, although nasogastric tubes were not found to be a risk factor for RTIs. We speculate that this lack of effect reflects the shorter duration of use of nasogastric tubes, which are likely replaced by more permanent enteral feeding tubes.…”

Section: Discussionmentioning

confidence: 99%

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Incidence, Risks, and Types of Infections in Pediatric Long-term Care Facilities

et al. 2017

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The population of infants, children, and adolescents cared for at pediatric long-term care facilities is increasing in complexity and size and thus consumes substantial health care resources. Infections are a significant cause of morbidity and mortality in this population, but few recent data describe their incidence and effects.OBJECTIVES To describe the types of infections diagnosed in residents of pediatric long-term care facilities, calculate infection rates, and identify risk factors for respiratory tract infections (RTIs). DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study, which was part of a larger trial called Keep It Clean for Kids, was conducted from September 1, 2012, to December 31, 2015, at 3 pediatric long-term care facilities in New York. Residents of the facilities who were 21 years or younger and either residents or admitted during the study period (n = 717) were enrolled in the study. Medical records were reviewed to identify infections diagnosed by site clinicians. MAIN OUTCOMES AND MEASURESIncidence of infections, such as RTIs; skin and soft-tissue infections; chronic comorbid conditions, including neurologic and respiratory disorders; and device use, including gastrostomy tubes and tracheostomies, was determined. Risk factors for RTIs were assessed by generalized linear mixed method regression modeling. RESULTSThe 717 residents had a median (interquartile range) age at enrollment of 2.6 (0.4-9.1) years; 358 (49.9%) were male. Four hundred twenty-eight residents (59.7%) had feeding tubes and 215 (30.0%) had tracheostomies. Most chronic comorbid conditions were musculoskeletal or ambulation (532 residents [74.2%]), neurologic (505 [70.4%]), respiratory (361 [50.3%]), and gastrointestinal (230 [32.1%]) disorders, and 460 residents (64.2%) had 4 or more chronic comorbid conditions. Site clinicians diagnosed 2052 infections during the 3-year study period. Respiratory tract infections were most common and were diagnosed in 1291 residents (62.9%). The overall infection rate was 5.3 infections per 1000 resident-days, and RTI rates were 3.3 infections per 1000 resident-days. Overall infection rates and rates of RTI, skin and soft-tissue infection, urinary tract infection, and bloodstream infection varied among the 3 sites. In the multivariable model, younger age (incidence rate ratio [IRR], 1.05; 95% CI, 1.03-1.06), increased number of chronic comorbid conditions (IRR, 1.12; 95% CI, 1.06-1.19), and the use of feeding tubes (IRR, 1.34; 95% CI, 1.03-1.64) and tracheostomies (IRR, 1.40; 95% CI, 1.17-1.69) were associated with RTIs. CONCLUSIONS AND RELEVANCEIn this study, RTIs were the most common infections diagnosed, but modifiable risk factors for RTIs were not identified. Future work should focus on optimizing infection prevention and control strategies to reduce infections, particularly RTIs, in the pediatric long-term care population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence, Risks, and Types of Infections in Pediatric Long-term Care Facilities

et al. 2017

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“…Children in pediatric long-term care likely have more frequent contact with a greater number and variety of staff members compared with residents in adult long-term care, which would make transmission events more likely. 4,6 Children also may be more susceptible to gastrointestinal and acute respiratory infections because of their age and immunologic immaturity. 5 Furthermore, viral pathogens that are more common among children (eg, rhinovirus) may be more likely to be spread via the droplet route and therefore less preventable through hand hygiene.…”

Section: Discussionmentioning

confidence: 99%

“…They rely on facility staff for assistance with all activities of daily living and require frequent hands-on contact from a variety of caregivers, thereby providing many opportunities for exposure to transmissible pathogens. 4 In addition, children in pediatric long-term care facilities have chronic medical conditions necessitating the use of indwelling devices, such as tracheostomy and feeding tubes, which place them at greater risk of infection. 5 Many pediatric long-term care residents are young and therefore have immature immune systems placing them at increased risk of infections.…”

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confidence: 99%