Does a Presurgical Antisepsis Protocol Decrease Surgical Site Infections in Young Children?

National standards for surgical site infection (SSI) prevention for children remain elusive. Our institution developed a presurgical antisepsis protocol that included the three components of chlorhexidine gluconate bathing wipes, chlorhexidine gluconate oral rinse, and povidone-iodine nasal swab. This retrospective cohort study examined data from electronic health records to compare SSI rates before and after protocol implementation. We included children aged 2 through 11 years undergoing any surgical procedure with the use of an incision in the OR (N = 1,356). We did not find any difference in the occurrence of SSI before and after the protocol was implemented. Logistic regression showed that an infection present at the time of surgery was the only significant predictor of an SSI. The implementation of a presurgical antisepsis protocol was not associated with SSI rate reduction in this pediatric cohort.

The voice of adolescents: Perceptions of isolation during hospitalization.

ABSTRACT: There is a lack of understanding of the pediatric patient experience in isolation. This qualitative, descriptive study interviewed adolescent patients during their hospital stay about their perception of isolation. This article analyzes the themes gleaned from the interviews as well as nursing practice implications and strategies in caring for young patients in isolation.

The Patient's Voice: Development of an Adolescent Hospital Quality of Care Survey (AHQOCS).

PURPOSE: To develop an adolescent determined hospital quality of care survey. BACKGROUND: Adolescents do not currently evaluate their quality of hospital care. Hospital satisfaction surveys are mailed following discharge to parents, and parental input may not reflect adolescent perception. DESIGN AND METHODS: This exploratory, descriptive study utilizing Q-sort methodology, investigated 60 adolescents/young adults' (ages 12-21) perception of hospital care. A comprehensive, peer-reviewed journal search conducted 1998-2017 explored adolescent perception of hospital care. Themes emerging from adolescent's perception of care were developed into 56 statements for relevance sorting. RESULTS: Excellent content validity of the care domains was established at 0.982 (utilizing the universal agreement). After placement of all 56 cards, items were correlated in order to reveal similarities in perspectives. Items of greatest importance to adolescents included 'able to tell the doctor what was wrong with you', 'having family stay', 'trust in nurse to take care of you', 'able to ask the doctor to explain what they said', 'nurse clearly told you what would happen to you', and 'a clean room'. Little variation in response occurred across the variables of age, gender, length of stay, or diagnosis. CONCLUSIONS: Given the opportunity to relate autonomously to health services, adolescents are able to determine quality preferences and should be contributory in determining hospital care. PRACTICE IMPLICATIONS: Based on adolescent preferences demonstrated in this study, satisfaction with pediatric care delivery should be improved with attention tailored to adolescent wishes.

How Do Youth with Cystic Fibrosis Perceive Their Readiness to Transition to Adult Healthcare Compared to Their Caregivers' Views?

PURPOSE: To describe how perceived stages of change for self-care management skills varies by age in youth with cystic fibrosis in preparation for transition to adult healthcare, to compare caregiver perception of youth readiness for self-care, and age/frequency of transition discussion with provider. DESIGN AND METHODS: The Transition Readiness Assessment Questionnaire and a modified version (TRAQ-C) for caregivers were used for data collection. Descriptive statistics, simple linear regression, and t-tests were employed. RESULTS: Regression equations suggest that age predicts youth perception of self-care management skill in all five domains on the TRAQ (p ≤ .009). A paired t-test compared the overall TRAQ and TRAQ-C mean scores between dyads. Youth rated themselves significantly higher in perception of self-care skill management (m = 3.187, sd = 0.769) than caregivers (m = 2.490, sd = 0.788; t = 7.408, df = 51, p < .001). Sixteen was the average age of transition discussion for both youth and caregiver. Reported frequency of discussion varied considerably. CONCLUSIONS: Although increasing age predicts perception of self-care management, many youth age 18-22 were still only contemplating or starting to learn skills. Skill level perceptions between youth and caregiver differed, but scores from all self-care management domains followed a similar trend. Discussions with providers began later than guidelines recommend and were often not recognized as such by youth. PRACTICE IMPLICATIONS: Results underscore the importance of beginning transition discussion and skill evaluation in youth with cystic fibrosis at an early age, incorporating caregivers' perception in the process.