474 Table 1. Pediatric Infection Prevention Process of Care Measures ICUs
Process of Care Measure
Contact precautionsa Central-line checklistb
Hand hygiene monitoringc
BBEa
Total antibiotic consumptiond
Daily CHG bathing
Date of Implementation Since inception of facility 2008 2008
2009 2012
2016
Observations in Compliance/Total Observations
556/573 511/539
46,862/48,040
7,069/9,920 N/A
N/A %
Compliance 97 95 98
71 N/A N/A
Note. ICU, intensive care unit; BBE, bare below the elbows; CHG, chlorhexidine gluconate; N/A, not available. aMonitoring for CP and BBE by trained hand hygiene monitors began in 2016. bMonitoring of central line checklist completion began in the ICUs in 2016. cMonitoring of hand-hygiene compliance data is for the complete study period from April 1, 2008 to March 31, 2018. dTotal antibiotic consumption data collected from August 2012 through December 2017.
Hospital-wide
Observations in Compliance/Total Observations
(371/392) NA
(76,378/80,346)
(9,076/13,454) N/A
N/A %
Compliance 95
N/A 95
67 N/A N/A
Emily J. Godbout et al
Table 2. Rate of MRSA, VRE and All Pathogens Central-Line Bloodstream Infections CLABSI, No. (Rate)a MRSA/VRE
Location ACP
PPCU PICU NICU Total
Traditional CPs 3 (0.28) 0 (0)
5 (0.55) 5 (0.39) 13 (0.38)
Discontinuation of CPs 1 (0.07) 1 (0.66) 2 (0.26) 2 (0.12) 6 (0.15)
P Value .24 .61 .44 .19 .06
Traditional CPs 28 (2.62) 2 (1.43) 27 (2.98) 50 (3.91) 107 (2.62)
acute-care pediatrics; PPCU, pediatric progressive care unit; PICU, pediatric intensive care unit; NICU, neonatal intensive care unit. aNo. of infections/1,000 central-line days. bBold indicates significance.
NICU, or all settings combined (Table 2). We observed no change in CLABSI rates due to all pathogens (including MRSA and VRE) in the PPCU or PICU. There was a statistically significant reduc- tion in the rate of CLABSI due to all pathogens in ACP, in the NICU, and in all settings combined. The process of care measures including CPs, daily CHG bathing, central-line checklist comple- tion, BBE approach, and HH are summarized in Table 1. Notably, HHcompliance was >90% hospital-wide for the 60 months before and after discontinuation of CPs. Monitoring for CPs and BBE by trained HH monitors began in 2016. Monitoring of central-line checklist completion began in the intensive care units (ICUs) in 2016. Daily CHG bathing occurs in patients with central lines and urinary catheters, but compliance data on this metric were not available. Record of antimicrobial consumption data across units began August 2012. The mean total antimicrobial consump- tion measured in days of therapy (DOT) per 1,000 patient days (PD) before and after discontinuation of CPs were 567 DOT per 1,000 PD and 500 DOT per 1,000 PD, respectively (P=.0164).
Discussion
We discontinued CPs for MRSA and VRE colonized or infected patients in 2013, and we observed no negative impact on CLABSI rates in pediatric patients at an academic children’s
hospital. We previously reported that discontinuation of CPs did not negatively impact device-associated HAI rates hospital- wide in combined adult and pediatric patients.5 This practice change was associated with an estimated annual cost savings of $500,000 across all inpatient populations.5 Importantly, patients with draining wounds or uncontained respiratory secretions and potentially at increased risk of transmitting MRSA or VRE remained on CPs. At CHoR, our pediatric services are integrated within a larger
adult facility. Reviewing our inpatient pediatric specific data, we observed an overall significant reduction in the rate of CLABSIs due to all pathogens during the study period, likely due to a hori- zontal infection prevention platform. Although individual infec- tion prevention strategies have an unknown impact on HAIs, bundled interventions yield improved clinical outcomes. Our find- ing is consistent with previously published reports of hospital- wide, sustained HAI decreases.6,7 We add to the growing body of literature that discontinuation
of CPs for MRSA or VRE infected or colonized patients does not adversely affect HAIs, specifically the rates of CLABSIs in pediatric patients. To our knowledge, this is the first study focused on the impact of discontinuation of CPs exclusively in pediatric patients. A study strength included standardized data collection by the infection prevention team employing NHSN CLABSI definitions.
All Pathogens
Discontinuation of CPs 21 (1.37) 3 (1.98) 16 (2.09) 31 (1.88) 71 (1.73)
P Valueb .03 .79 .28 .00 .00
Note. CLABSI, central-line associated bloodstream infections, MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant Enterococcus; CP, contact precautions; ACP,
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