389. A Multidimensional Quality Improvement Initiative to Reduce Pediatric Healthcare-Associated Respiratory Viral Infections
Session: Poster Abstract Session: HAI: Pediatrics
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Hei Poster - ID Week - HAVI FINAL.pdf (756.6 kB)
  • Background:  Healthcare-associated respiratory viral infections (HA-RVI) are common in hospitalized children and can lead to poor outcomes, including escalation of care and even death. Few data are available on quality improvement (QI) initiatives to reduce HA-RVI in pediatric populations. A multidimensional QI bundle was created and implemented in a pediatric setting. This novel QI bundle included hand hygiene, visitor screening for respiratory or GI illness, limited visitation during peak respiratory viral season (typically December 1 – March 31), enhanced sick employee policy, transmission-based precautions triggered by patient symptoms, and improved environmental cleanliness. Our objective was to assess the impact of the QI bundle on the rate of HA-RVI.

    Methods:  A retrospective observational study compared the monthly rate of HA-RVI (per 1000 patient days) and bundle compliance at a tertiary care children’s hospital over a 4-year period. HA-RVI were identified from existing surveillance data and met National Healthcare Safety Network (NHSN) criteria for upper respiratory infections or pneumonia caused by a laboratory-confirmed viral pathogen. Implementation of the QI bundle was achieved through iterative improvement cycles using a structured improvement framework (Plan-Do-Study-Act). Each HA-RVI was evaluated through a structured event review process. Feedback of monthly HA-RVI data, rates of compliance for select bundle elements, and themes from event reviews were provided through an institutional workgroup with representation from all inpatient units.

    ResultsThe average HA-RVI rate in season 1 (July 2012-June 2013) was 0.56 infections/1000 patient days. The seasonal average HA-RVI rates in seasons 2-4 ranged between 0.40-0.44 infections/1000 patients days (average = 0.42), representing a 21% decrease.  Increasing hand hygiene and visitor screening compliance correlated with a decreasing rate of HA-RVI over a 4-year period (Figure 1).

    Conclusion:  We observed an inverse correlation between compliance to QI bundle elements and HA-RVI rates. Additional data on risk factors for HA-RVI in hospitalized children are needed to guide development of more targeted improvement efforts.


    Figure 1


     

    Hillary Hei, MPH1, Cindy Hoegg, BSN, RN, CIC2, Sarah Smathers, MPH, CIC2, Susan Coffin, MD, MPH, FSHEA, FPIDS3 and Julia Shaklee Sammons, MD, MSCE4, (1)Department of Infection Prevention and Control, The Children's Hospital of Philadephia, Philadelphia, PA, (2)Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, PA, (3)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (4)Perelman School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, PA

    Disclosures:

    H. Hei, None

    C. Hoegg, None

    S. Smathers, None

    S. Coffin, None

    J. S. Sammons, None

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