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BACKGROUND: While COVID-19 vaccine (CV) acceptance is improving, little is known about parental acceptance of CV in the pediatric emergency department (PED). OBJECTIVES: The aims of the study are to assess rates of CV uptake among eligible children presenting to the PED, describe caregiver willingness to accept CV in the PED, and assess potential ED-based interventions to increase CV acceptance. METHODS: We surveyed caregivers of 384 children aged ≥6 months presenting to the PED for minor illness/injury. Demographics, COVID-19/other vaccine history, and intent/willingness to receive CV were recorded. Participants were recontacted by phone 6-12 months after vaccine eligibility to assess CV status, barriers to CV, willingness to receive CV in the ED, and preferences for ED-based vaccine-related interventions. Data were analyzed using standard descriptive statistics. RESULTS: In initial surveys, 31.6% of caregivers planned to vaccinate their child; 32.2% would likely accept CV in the PED. Follow-up data was available for 302 (78.6%) previously unvaccinated participants; only 59 (19.5%) had received CV at follow-up. Of those unvaccinated at follow-up, 27 (28.7%) intended to vaccinate, nearly all of whom would accept CV in the PED. Factors associated with increased likelihood of vaccination included initial intent to vaccinate (P = 0.004), definite/probable acceptance of CV in the PED (P = 0.035), and child age 5+ (P = 0.005). Nearly one-fourth of unvaccinated families reported barriers to CV access. Interventions most likely to persuade families to vaccinate included: discussing CV with a provider (25.5%), receiving an information sheet (23.4%), and offering CV without an ED visit (22.3%). CONCLUSIONS: CV acceptance was low in this cohort. A gap population of unvaccinated children whose caregivers intend to vaccinate exists, and many of these would accept CV in the ED. This data supports the presence of CV programs in the ED to close this gap.
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Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science research has led to improvements in our understanding of effective strategies for HAI prevention. Despite these advances, HAIs continue to affect â¼1 of every 31 hospitalized patients, leading to substantial morbidity, mortality, and excess healthcare expenditures, and persistent gaps remain between what is recommended and what is practiced.The widespread impact of the coronavirus disease 2019 (COVID-19) pandemic on HAI outcomes in acute-care hospitals has further highlighted the essential role of infection prevention programs and the critical importance of prioritizing efforts that can be sustained even in the face of resource requirements from COVID-19 and future infectious diseases crises.The Compendium: 2022 Updates document provides acute-care hospitals with up-to-date, practical expert guidance to assist in prioritizing and implementing HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Disease Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), the Surgical Infection Society (SIS), and others.
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COVID-19 , Infecção Hospitalar , Criança , Humanos , Doenças Transmissíveis/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Atenção à Saúde , Hospitais , Estados Unidos/epidemiologia , Pandemias , Controle de Doenças TransmissíveisRESUMO
This document is part of the "SHEA Neonatal Intensive Care Unit (NICU) White Paper Series." It is intended to provide practical, expert opinion, and/or evidence-based answers to frequently asked questions about CLABSI detection and prevention in the NICU. This document serves as a companion to the CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Prevention of Infections in Neonatal Intensive Care Unit Patients. Central line-associated bloodstream infections (CLABSIs) are among the most frequent invasive infections among infants in the NICU and contribute to substantial morbidity and mortality. Infants who survive CLABSIs have prolonged hospitalization resulting in increased healthcare costs and suffer greater comorbidities including worse neurodevelopmental and growth outcomes. A bundled approach to central line care practices in the NICU has reduced CLABSI rates, but challenges remain. This document was authored by pediatric infectious diseases specialists, neonatologists, advanced practice nurse practitioners, infection preventionists, members of the HICPAC guideline-writing panel, and members of the SHEA Pediatric Leadership Council. For the selected topic areas, the authors provide practical approaches in question-and-answer format, with answers based on consensus expert opinion within the context of the literature search conducted for the companion HICPAC document and supplemented by other published information retrieved by the authors. Two documents in the series precede this one: "Practical approaches to Clostridioides difficile prevention" published in August 2018 and "Practical approaches to Staphylococcus aureus prevention," published in September 2020.
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Infecções Relacionadas a Cateter , Sepse , Infecções Estafilocócicas , Lactente , Recém-Nascido , Humanos , Criança , Unidades de Terapia Intensiva Neonatal , Controle de Infecções/métodos , Infecções Relacionadas a Cateter/prevenção & controle , Infecções Estafilocócicas/complicaçõesAssuntos
Doenças Transmissíveis , Infectologia , Criança , Humanos , Doenças Transmissíveis/epidemiologiaRESUMO
OBJECTIVES: We evaluated the impact of a test-to-stay (TTS) program on within-school transmission and missed school days in optionally masked kindergarten through 12th grade schools during a period of high community severe acute respiratory syndrome coronavirus 2 transmission. METHODS: Close contacts of those with confirmed severe acute respiratory syndrome coronavirus 2 infection were eligible for enrollment in the TTS program if exposure to a nonhousehold contact occurred between November 11, 2021 and January 28, 2022. Consented participants avoided school exclusion if they remained asymptomatic and rapid antigen testing at prespecified intervals remained negative. Primary outcomes included within-school tertiary attack rate (test positivity among close contacts of positive TTS participants) and school days saved among TTS participants. We estimated the number of additional school-acquired cases resulting from TTS and eliminating school exclusion. RESULTS: A total of 1675 participants tested positive or received at least 1 negative test between days 5 and 7 and completed follow-up; 92% were students and 91% were exposed to an unmasked primary case. We identified 201 positive cases. We observed a tertiary attack rate of 10% (95% confidence interval: 6%-19%), and 7272 (89%) of potentially missed days were saved through TTS implementation. We estimated 1 additional school-acquired case for every 21 TTS participants remaining in school buildings during the entire study period. CONCLUSIONS: Even in the setting of high community transmission, a TTS strategy resulted in substantial reduction in missed school days in optionally masked schools.
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COVID-19 , SARS-CoV-2 , Humanos , COVID-19/prevenção & controle , Instituições Acadêmicas , IncidênciaRESUMO
OBJECTIVES: We evaluated the safety and efficacy of a test-to-stay program for unvaccinated students and staff who experienced an unmasked, in-school exposure to someone with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Serial testing instead of quarantine was offered to asymptomatic contacts. We measured secondary and tertiary transmission rates within participating schools and in-school days preserved for participants. METHODS: Participating staff or students from universally masked districts in North Carolina underwent rapid antigen testing at set intervals up to 7 days after known exposure. Collected data included location or setting of exposure, participant symptoms, and school absences up to 14 days after enrollment. Outcomes included tertiary transmission, secondary transmission, and school days saved among test-to-stay participants. A prespecified interim safety analysis occurred after 1 month of enrollment. RESULTS: We enrolled 367 participants and completed 14-day follow-up on all participants for this analysis. Nearly all (215 of 238, 90%) exposure encounters involved an unmasked index case and an unmasked close contact, with most (353 of 366, 96%) occurring indoors, during lunch (137 of 357, 39%) or athletics (45 of 357, 13%). Secondary attack rate was 1.7% (95% confidence interval: 0.6%-4.7%) based on 883 SARS-CoV-2 serial rapid antigen tests with results from 357 participants; no tertiary cases were identified, and 1628 (92%) school days were saved through test-to-stay program implementation out of 1764 days potentially missed. CONCLUSION: After unmasked in-school exposure to SARS-CoV-2, even in a mostly unvaccinated population, a test-to-stay strategy is a safe alternative to quarantine.
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COVID-19 , SARS-CoV-2 , COVID-19/epidemiologia , Teste para COVID-19 , Humanos , Quarentena , Instituições AcadêmicasRESUMO
Antibiotics are among the most common medications prescribed in nursing homes. The annual prevalence of antibiotic use in residents of nursing homes ranges from 47% to 79%, and more than half of antibiotic courses initiated in nursing-home settings are unnecessary or prescribed inappropriately (wrong drug, dose, or duration). Inappropriate antibiotic use is associated with a variety of negative consequences including Clostridioides difficile infection (CDI), adverse drug effects, drug-drug interactions, and antimicrobial resistance. In response to this problem, public health authorities have called for efforts to improve the quality of antibiotic prescribing in nursing homes.
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Infecções por Clostridium , Casas de Saúde , Antibacterianos/uso terapêutico , Infecções por Clostridium/tratamento farmacológico , Humanos , Reprodutibilidade dos TestesRESUMO
OBJECTIVES: To determine if training residents in a structured communication method elicits specific behaviors in a laboratory model of interaction with vaccine-hesitant parents. STUDY DESIGN: Standardized patients portraying vaccine-hesitant parents were used to assess the effectiveness of training in the Announce, Inquire, Mirror, Secure (AIMS) Method for Healthy Conversations. Blinded pediatric residents were pseudorandomized to receive AIMS or control training and underwent pre- and post-training encounters with blinded standardized patients. Encounters were assessed by blinded raters using a novel tool. Participant confidence and standardized patient evaluations of the participants' general communication skills were assessed. RESULTS: Ratings were available for 27 AIMS and 26 control participants. Statistically significant increases in post-training scores (maximum = 30) were detected in AIMS, but not in control, participants (median, 21.3 [IQR, 19.8-24.8] vs 18.8 [IQR, 16.9-20.9]; P < .001). Elements (maximum score = 6) with significant increases were Inquire (0.67 [IQR, 0-1.76] vs -0.33 [IQR, -0.67 to 0.33]; P < .001); Mirror (1.33 [IQR, 0 to 2] vs -0.33 [IQR, -0.92 to 0]; P < .001) and Secure (0.33 [IQR, 0 to 1.67] vs -0.17 [IQR, -0.67 to 0.33]; P = .017). Self-confidence increased equally in both groups. Standardized patients did not detect a difference in communication skills after training and between groups. Internal consistency and inter-rater reliability of the assessment tool were modest. CONCLUSIONS: Standardized patients proved useful in studying the effectiveness of structured communication training, but may have been limited in their ability to perceive a difference between groups owing to the predetermined encounter outcome of vaccine refusal. AIMS training should be studied in real-world scenarios to determine if it impacts vaccine acceptance.
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Competência Clínica , Comunicação , Internato e Residência/métodos , Educação de Pacientes como Assunto/métodos , Pediatria/educação , Relações Médico-Paciente , Hesitação Vacinal , Adulto , Método Duplo-Cego , Feminino , Humanos , Lactente , Kentucky , Masculino , Pais , Simulação de PacienteRESUMO
BACKGROUND AND OBJECTIVES: International guidelines suggest a target culture-negative peritonitis rate of <15% among patients receiving long-term peritoneal dialysis. Through a pediatric multicenter dialysis collaborative, we identified variable rates of culture-negative peritonitis among participating centers. We sought to evaluate whether specific practices are associated with the variability in culture-negative rates between low- and high-culture-negative rate centers. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Thirty-two pediatric dialysis centers within the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) collaborative contributed prospective peritonitis data between October 1, 2011 and March 30, 2017. Clinical practice and patient characteristics were compared between centers with a ≤20% rate of culture-negative peritonitis (low-rate centers) and centers with a rate >20% (high-rate centers). In addition, centers completed a survey focused on center-specific peritoneal dialysis effluent culture techniques. RESULTS: During the 5.5 years of observation, 1113 patients had 1301 catheters placed, totaling 19,025 patient months. There were 620 episodes of peritonitis in 378 patients with 411 catheters; cultures were negative in 165 (27%) peritonitis episodes from 125 (33%) patients and 128 (31%) catheters. Low-rate centers more frequently placed catheters with a downward-facing exit site and two cuffs (P<0.001), whereas high-rate centers had more patients perform dialysis themselves without the assistance of an adult care provider (P<0.001). The survey demonstrated that peritoneal dialysis effluent culture techniques were highly variable across centers. No consistent practice or technique helped to differentiate low- and high-rate centers. CONCLUSIONS: Culture-negative peritonitis is a frequent complication of maintenance peritoneal dialysis in children. Despite published recommendations for dialysis effluent collection and culture methods, great variability in culture techniques and procedures exists among individual dialysis programs and respective laboratory processes.
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Instituições de Assistência Ambulatorial/estatística & dados numéricos , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/normas , Peritonite/microbiologia , Manejo de Espécimes/normas , Adolescente , Técnicas Bacteriológicas/normas , Cateterismo/efeitos adversos , Cateteres de Demora/efeitos adversos , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Soluções para Diálise , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Autocuidado/estatística & dados numéricos , Estados UnidosAssuntos
COVID-19 , Criança , Hospitalização , Hospitais , Humanos , Estudos Prospectivos , SARS-CoV-2Assuntos
COVID-19 , Atenção à Saúde , Pessoal de Saúde , Humanos , Prevalência , SARS-CoV-2 , WashingtonAssuntos
COVID-19 , Pandemias , Criança , Humanos , Cidade de Nova Iorque/epidemiologia , SARS-CoV-2 , Índice de Gravidade de DoençaRESUMO
Pediatric infectious diseases physicians are dedicated to the diagnosis, prevention, and management of infections in children. As such, we play large, and important, roles in the clinical care of children from birth to late adolescence and in infection prevention, antimicrobial stewardship, research pertaining to infections, public health, international and global health, and advocacy for children's health. Furthermore, we are critical to the education of future physicians (in general), pediatricians, and infectious diseases doctors. In addition to diagnosing and treating bacterial, fungal, viral, and parasitic infections known through the ages, we have been at the forefront of meeting today's new infectious threats to children's health, which include the following: antibiotic-resistant organisms; hospital-acquired infections; global outbreaks such as Ebola, Zika, human immunodeficiency virus-acquired immune deficiency syndrome, and new strains of influenza; infections in immunocompromised children; vaccine-preventable infections; the inefficient use of medical resources; and the high cost of medical care.
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Mão de Obra em Saúde/tendências , Infectologia/tendências , Pediatria/tendências , Escolha da Profissão , Certificação , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Infectologia/normas , Pediatria/normas , Estados UnidosRESUMO
The use of monthly intranasal mupirocin was associated with a significant reduction in the rate of methicillin-resistant Staphylococcus aureus transmission and Staphylococcus aureus invasive infection in a large neonatal intensive care unit. Resistance to mupirocin emerged over time, but it was rare and was not associated with adverse clinical outcomes.Infect Control Hosp Epidemiol 2018;39:741-745.
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Antibacterianos/uso terapêutico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/prevenção & controle , Administração Intranasal , Antibioticoprofilaxia/métodos , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Análise de Séries Temporais Interrompida , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Mupirocina , Análise de RegressãoRESUMO
BACKGROUND: Effective communication is an essential element of medical care and a priority of medical education. Specific interventions to teach communication skills are at the discretion of individual residency programs. OBJECTIVE: We developed the Resident Communication Skills Curriculum (RCSC), a formal curriculum designed to teach trainees the communication skills essential for high-quality practice. METHODS: A multidisciplinary working group contributed to the development of the RCSC, guided by an institutional needs assessment, literature review, and the Accreditation Council for Graduate Medical Education core competencies. The result was a cohesive curriculum that incorporates didactic, role play, and real-life experiences over the course of the entire training period. Methods to assess curricular outcomes included self-reporting, surveys, and periodic faculty evaluations of the residents. RESULTS: Curricular components have been highly rated by residents (3.95-3.97 based on a 4-point Likert scale), and residents' self-reported communication skills demonstrated an improvement over the course of residency in the domains of requesting a consultation, providing effective handoffs, handling conflict, and having difficult conversations (intern median 3.0, graduate median 4.0 based on a 5-point Likert scale, P ≤ .002). Faculty evaluations of residents have also demonstrated improvement over time (intern median 3.0, graduate median 4.5 based on a 5-point Likert scale, P < .001). CONCLUSIONS: A comprehensive, integrated communication skills curriculum for pediatrics residents was implemented, with a multistep evaluative process showing improvement in skills over the course of the residency program. Positive resident evaluations and informal comments from faculty support its general acceptance. The use of existing resources makes this curriculum feasible.
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Comunicação , Currículo , Internato e Residência , Pediatria/educação , Educação de Pós-Graduação em Medicina , Hospitais Pediátricos , Humanos , Negociação , Transferência da Responsabilidade pelo PacienteRESUMO
The scope of a healthcare institution's infection prevention and control/healthcare epidemiology program (IPC/HE) should be driven by the size and complexity of the patient population served, that population's risk for healthcare-associated infection (HAI), and local, state, and national regulatory and accreditation requirements. Essential activities of all IPC/HE programs include but are not limited to the following: â Surveillance.â Performance improvement to reduce HAI â Acute event response, including outbreak investigation â Education and training of both healthcare personnel and patients â Reporting of HAI to the Centers for Disease Control and Prevention's National Healthcare Safety Network as well as entities required by law.