No excuses, no exceptions except with compassion: A narrative review of visitor aggression in pediatrics.

Visitor aggression in pediatrics is a form of workplace violence that has not received much focus across pediatric health care systems. There are many different practices, strategies, and policies implemented across children's hospitals to mitigate visitor aggression on both clinical and organizational levels. To date, there has not been a published review on interventions in pediatrics to de-escalate the intensity of these circumstances in the context of providing care and treatment to children. The goals of this review are to identify and assess the efficacy of each effort implemented across diverse pediatric health care settings. This review also proposes research, organizational, clinical, and policy implications and considerations that could help inform future practice in hospital-based violence prevention. A narrative review of the literature identified eleven peer-reviewed studies that delineated practices, strategies, and educational efforts between 1994 and 2020. All studies were descriptive in nature. There were four cross-sectional studies, three qualitative studies, one mixed-methods study, two prospective studies (one of which also had a group comparison design), and one non-experimental study. The primary measures implemented across children's hospitals involved increasing security and police presence in patient care areas (n = 3), development of multidisciplinary workgroups to review and revise visitation policies (n = 2), crisis response teams (n = 2), and incident reporting systems (n = 2). Hospital risk management, administration, and clinical leadership teams were stakeholders involved in designing interventions across studies. Hospitals varied in allocation of support resources and in defining visitor aggression which contributed to mixed findings across studies.

Recovery of multidrug-resistant bacteria from combat personnel evacuated from Iraq and Afghanistan at a single military treatment facility.

U.S. combat casualties from Iraq and Afghanistan continue to develop infections with multidrug-resistant (MDR) bacteria. This study assesses the infection control database and clinical microbiology antibiograms at a single site from 2005 to 2007, a period when all Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF) casualties admitted to the facility underwent initial isolation and screening for MDR pathogens. During this 3-year period, there were 2,242 OIF/OEF admissions: 560 in 2005, 724 in 2006, and 958 in 2007. The most commonly recovered pathogens from OIF/OEF admission screening cultures were methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae and Acinetobacter. The yearly nosocomial infection rate of these three pathogens among OIF/OEF admissions ranged between 2 and 4%. There were remarkable changes in resistance profiles for Acinetobacter, K. pneumoniae, and S. aureus over time. Despite aggressive infection control procedures, there is continued nosocomial transmission within the facility and increasing antimicrobial resistance in some pathogens. Novel techniques are needed to control the impact of MDR bacteria in medical facilities.

Evaluation of potential environmental contamination sources for the presence of multidrug-resistant bacteria linked to wound infections in combat casualties.

OBJECTIVE: To determine whether multidrug-resistant (MDR) gram-negative organisms are present in Afghanistan or Iraq soil samples, contaminate standard deployed hospital or modular operating rooms (ORs), or aerosolize during surgical procedures. DESIGN: Active surveillance. SETTING: US military hospitals in the United States, Afghanistan, and Iraq. METHODS: Soil samples were collected from sites throughout Afghanistan and Iraq and analyzed for presence of MDR bacteria. Environmental sampling of selected newly established modular and deployed OR high-touch surfaces and equipment was performed to determine the presence of bacterial contamination. Gram-negative bacteria aerosolization during OR surgical procedures was determined by microbiological analysis of settle plate growth. RESULTS: Subsurface soil sample isolates recovered in Afghanistan and Iraq included various pansusceptible members of Enterobacteriaceae, Vibrio species, Pseudomonas species, Acinetobacter lwoffii, and coagulase-negative Staphylococcus (CNS). OR contamination studies in Afghanistan revealed 1 surface with a Micrococcus luteus. Newly established US-based modular ORs and the colocated fixed-facility ORs revealed no gram-negative bacterial contamination prior to the opening of the modular OR and 5 weeks later. Bacterial aerosolization during surgery in a deployed fixed hospital revealed a mean gram-negative bacteria colony count of 12.8 colony-forming units (CFU)/dm(2)/h (standard deviation [SD], 17.0) during surgeries and 6.5 CFU/dm(2)/h (SD, 7.5; [Formula: see text]) when the OR was not in use. CONCLUSION: This study demonstrates no significant gram-negative bacilli colonization of modular and fixed-facility ORs or dirt and no significant aerosolization of these bacilli during surgical procedures. These results lend additional support to the role of nosocomial transmission of MDR pathogens or the colonization of the patient themselves prior to injury.