Behavioral Interventions to Reduce Infections in Pediatric Long-term Care Facilities: The Keep It Clean for Kids Trial.

Children in pediatric long-term care facilities (pLTCF) represent a highly vulnerable population and infectious outbreaks occur frequently, resulting in significant morbidity, mortality, and resource use. The purpose of this quasi-experimental trial using time series analysis was to assess the impact of a 4-year theoretically based behavioral intervention on infection prevention practices and clinical outcomes in three pLTCF (288 beds) in New York metropolitan area including 720 residents, ages 1 day to 26 years with mean lengths of stay: 7.9-33.6 months. The 5-pronged behavioral intervention included explicit leadership commitment, active staff participation, work flow assessments, training staff in the World Health Organization "'five moments of hand hygiene (HH)," and electronic monitoring and feedback of HH frequency. Major outcomes were HH frequency, rates of infections, number of hospitalizations associated with infections, and outbreaks. Mean infection rates/1000 patient days ranged from 4.1-10.4 pre-intervention and 2.9-10.0 post-intervention. Mean hospitalizations/1000 patient days ranged from 2.3-9.7 before and 6.4-9.8 after intervention. Number of outbreaks/1000 patient days per study site ranged from 9-24 pre- and 9-18 post-intervention (total = 95); number of cases/outbreak ranged from 97-324 (total cases pre-intervention = 591 and post-intervention = 401). Post-intervention, statistically significant increases in HH trends occurred in one of three sites, reductions in infections in two sites, fewer hospitalizations in all sites, and significant but varied changes in the numbers of outbreaks and cases/outbreak. Modest but inconsistent improvements occurred in clinically relevant outcomes. Sustainable improvements in infection prevention in pLTCF will require culture change; increased staff involvement; explicit administrative support; and meaningful, timely behavioral feedback.

Clinical status: a daily forum for resident discussion and staff education.

A forum at which the timely transmission of critical clinical information is coupled with a formal interdisciplinary teaching program has tremendous value in the long-term care setting. We have combined features of morning report used in teaching hospitals with attributes of "stand-up" meetings to fill this need. Each morning we hold Clinical Status, a gathering of representative staff from all neighborhoods (units) at which we discuss problems that have occurred during the previous 24 hours; admissions, discharges, and transitions; Center-wide concerns such as infection control measures; and upcoming events such as celebrations, lectures, and memorials. In addition, short educational presentations are made by staff members at each session. A survey of attendees confirms our impression that Clinical Status is regarded as an informative, stimulating and vital aspect of life at the Center.

Genetic disorders and congenital malformations in pediatric long-term care.

OBJECTIVE: The objective of this study was to gain insight into the contribution of genetic disorders and congenital malformations to residents of a pediatric long-term care and rehabilitation center. DESIGN: Record review. SETTING: The setting was a 136-bed long-term care and rehabilitation center in New York City. PARTICIPANTS: Participants were residents who spent 1 day or longer as in-patients at the center over a 1-year period of time. MEASUREMENTS: Resident diagnoses were categorized as problems with known genetic basis, problems with presumed genetic basis, acquired disorders with genetic predisposition, contiguous gene syndromes, multiple congenital anomalies, prematurity, cerebral palsy, hypoxic ischemic encephalopathy, conditions with unknown etiology, and defined conditions without genetic basis. The percentage of individuals with genetic disorders and/or congenital malformations was determined. RESULTS: Genetic disorders and congenital anomalies were responsible for 50% of overall admissions and 60% of end-of-life care admissions to a pediatric long-term care center. CONCLUSION: An understanding of the contribution of genetic disorders and congenital malformations can assist long-term care administrators as they plan for the needs of their future residents.