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We used the Pediatric Health Information System database to assess the use of antibiotics reserved for the treatment of resistant Gram-negative infections in children from 2004 to 2014. Overall, use of these agents increased in children from 2004 to 2007 and subsequently decreased.
To develop a candidate definition for central line–associated bloodstream infection (CLABSI) in neonates with presumed mucosal barrier injury due to gastrointestinal (MBI-GI) conditions and to evaluate epidemiology and microbiology of MBI-GI CLABSI in infants
Multicenter retrospective cohort study.
Neonatal intensive care units from 14 US children’s hospitals and pediatric facilities.
A multidisciplinary focus group developed a candidate MBI-GI CLABSI definition based on presence of an MBI-GI condition, parenteral nutrition (PN) exposure, and an eligible enteric organism. CLABSI surveillance data from participating hospitals were supplemented by chart review to identify MBI-GI conditions and PN exposure.
During 2009–2012, 410 CLABSIs occurred in 376 infants. MBI-GI conditions and PN exposure occurred in 149 (40%) and 324 (86%) of these 376 neonates, respectively. The distribution of pathogens was similar among neonates with versus without MBI-GI conditions and PN exposure. Fifty-nine (16%) of the 376 initial CLABSI episodes met the candidate MBI-GI CLABSI definition. Subsequent versus initial CLABSIs were more likely to be caused by an enteric organism (22 of 34 [65%] vs 151 of 376 [40%]; P = .009) and to meet the candidate MBI-GI CLABSI definition (19 of 34 [56%] vs 59 of 376 [16%]; P < .01).
While MBI-GI conditions and PN exposure were common, only 16% of initial CLABSIs met the candidate definition of MBI-GI CLABSI. The high proportion of MBI-GI CLABSIs among subsequent infections suggests that infants with MBI-GI CLABSI should be a population targeted for further surveillance and interventional research.
Infect Control Hosp Epidemiol 2014;35(11):1391–1399
This white paper identifies knowledge gaps and new challenges in healthcare epidemiology research, assesses the progress made toward addressing research priorities, provides the Society for Healthcare Epidemiology of America (SHEA) Research Committee's recommendations for high-priority research topics, and proposes a road map for making progress toward these goals. It updates the 2010 SHEA Research Committee document, “Charting the Course for the Future of Science in Healthcare Epidemiology: Results of a Survey of the Membership of SHEA,” which called for a national approach to healthcare-associated infections (HAIs) and a prioritized research agenda. This paper highlights recent studies that have advanced our understanding of HAIs, the establishment of the SHEA Research Network as a collaborative infrastructure to address research questions, prevention initiatives at state and national levels, changes in reporting and payment requirements, and new patterns in antimicrobial resistance.
The Society for Healthcare Epidemiology of America (SHEA) guideline “Infection Prevention and Control in Residential Facilities for Pediatric Patients and Their Families” is the first infection prevention and control (IPC) guideline to address preventing transmission of infectious agents in “home away from home” residential settings, of which the Ronald McDonald Houses (RMHs) serve as a prototype. These types of facilities provide support services, including overnight lodging, for ill and injured children and their families. Food preparation occurs in common areas, and cleaning of rooms or apartments is performed by the occupants during their stay and before departure. Pediatric patients are frequent guests of the family-centered facilities while receiving or recovering from specialized medical therapy. Examples of high-risk populations served in these facilities include families of patients with cancer, recipients of stem cell or solid organ transplants, surgical and/or very-low-birthweight infants who receive care in neonatal intensive care units (NICUs), those with cystic fibrosis, and women with high-risk pregnancies awaiting delivery in a nearby medical center. Such facilities are located worldwide and vary in their physical structure and the predominant population served.
We surveyed Ronald McDonald Houses (RMHs) to assess infection prevention and control (IPC) practices. A diverse patient population is served by RMH. Most sites have locally written IPC guidelines, and consultation resources vary, increasing the potential for inconsistent IPC practices. RMH would benefit from a standardized IPC guideline.
Multidrug resistant organisms (MDROs) and healthcare-associated infections (HAIs) are associated with increased lengths of hospital stay, increased costs, and increased mortality. We explore the scope of MDRO HAIs in children, current MDRO HAI prevention practices and data to support these practices, and we propose research topics targeting MDRO HAI prevention in children.
Viral respiratory infections pose a significant challenge to pediatric infection prevention programs. We explore issues regarding the prevention of viral respiratory infections by discussing transmission of influenza A virus, isolation of infected patients, and hospital programs for influenza vaccination.
Central line–associated bloodstream infections cause morbidity and mortality in children. We explore the evidence for prevention of central line–associated bloodstream infections in children, assess current practices, and propose research topics to improve prevention strategies.
Varicella is highly contagious, and immunocompromised patients are at increased risk of severe illness, including disseminated disease, pneumonia, and encephalitis. We describe an outbreak of varicella with likely breakthrough disease in a population of pediatric cancer patients in October 2004.
A 250-bed tertiary care pediatric facility with a 33-bed oncology unit, outpatient clinics, and affiliated group housing and schoolroom spaces.
We defined varicella as an acute illness with a maculopapulovesicular rash, without other apparent cause. We defined breakthrough disease as varicella with onset more than 42 days after vaccination. Cancer patients were considered to be nonimmune if serologic test results were negative for varicella-zoster virus. Family members were considered to be nonimmune if they had no history of infection with wild-type varicella-zoster virus or of varicella vaccination.
In a period of approximately 16 days, varicella was detected in 7 children (the index case, 5 secondary cases, and 1 tertiary case). Of the 7 identified cases, 4 appeared to be cases of breakthrough disease in previously vaccinated children. The outbreak resulted in the exposure of 82 families at a pediatric group housing facility; 28 children at the schoolroom; and 77 patients, 150 family members, and 9 staff members at 3 outpatient clinics.
This outbreak highlights the important role that breakthrough varicella can play in healthcare centers with affiliated group housing. Formal recommendations on the management of exposed individuals who have been vaccinated should be made in such settings, especially if immunocompromised hosts are present.
Pertussis outbreaks in healthcare settings result in resource-intensive control activities, but studies have rarely evaluated the associated costs. We describe and estimate costs associated with 2 nosocomial pertussis outbreaks in King County, Washington, during the period from July 25 to September 15, 2004. One outbreak occurred at a 500-bed tertiary care hospital (hospital A), and the other occurred at a 250-bed pediatric hospital (hospital B).
We estimated the costs of each outbreak from the hospitals' perspective through standardized interviews with hospital staff and review of contact tracing logs. Direct costs included personnel time and laboratory and medication costs, whereas indirect costs were those resulting from hospital staff furloughs.
Hospital A incurred direct costs of $195,342 and indirect costs of $68,015; hospital B incurred direct costs of $71,130 and indirect costs of $50,000. Cost differences resulted primarily from higher personnel costs at hospital A ($134,536), compared with hospital B ($21,645). Total cost per pertussis case was $43,893 for hospital A (6 cases) and $30,282 for hospital B (4 cases). Total cost per person exposed to a pertussis patient were $357 for hospital A (738 exposures) and $164 for hospital B (737 exposures).
Nosocomial pertussis outbreaks result in substantial costs to hospitals, even when the number of pertussis cases is low. The cost-effectiveness of strategies to prevent nosocomial pertussis outbreaks, including vaccination of healthcare workers, should be evaluated.
To describe a nosocomial outbreak of Salmonella serotype Saintpaul gastroenteritis and to explore risk factors for infection.
A 208-bed, university-affiliated children's hospital.
Patients hospitalized at Children's Hospital and Regional Medical Center, Seattle, Washington, during February 2001 who had stool specimens obtained for culture at least 24 hours after admission. Case-patients (n = 11) were patients with an indistinguishable strain of Salmonella Saintpaul cultured from their stool. Control-patients (n = 41) were patients hospitalized for problems other than gastroenteritis whose stool cultures were negative for Salmonella.
Risk factors were evaluated using the chisquare test or Fisher's exact test. Continuous variables were compared using the Mann–Whitney U test. A multivariable analysis was performed using logistic regression. The predictor of interest was the receipt of enteral feeding formula mixed by the hospital.
Case-patients were more likely than control-patients to have received formula mixed by the hospital (OR, 4.2; 95% confidence interval, 1.04 to 17.16). Other variables evaluated were not significant predictors of Salmonella Saintpaul infection.
Formula mixed by the hospital appears to have been the source of this Salmonella outbreak. Strict sanitation measures must be ensured in formula preparation and delivery, and bacterial pathogens should be included in the differential diagnosis for nosocomial gastroenteritis.
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