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 childrens 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.
Results: The 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.
S. Smathers, None
S. Coffin, None
J. S. Sammons, None