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Fatemi Y, Costello A, Lieberman L, Hart J, Shaw KN, Shea JA, Coffin S. Clinical pathways and diagnostic reasoning: A qualitative study of pediatric residents' and hospitalists' perceptions. J Hosp Med 2023; 18:139-146. [PMID: 36424711 DOI: 10.1002/jhm.13010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/11/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical pathways are evidence-based guidelines adapted to local settings. They have been shown to improve patient outcomes and reduce resource utilization. However, it is unknown how physicians integrate clinical pathways into their clinical reasoning. METHODS We conducted a single-center qualitative study involving one-on-one semi-structured interviews of pediatric residents and pediatric hospitalist attendings between August 2021 and March 2022. Interviews were audio-recorded and professionally transcribed. We utilized a qualitative descriptive framework to code data and identify themes. RESULTS We interviewed 15 pediatric residents and 12 pediatric hospitalists. Thematic analysis of interview transcripts revealed four themes related to physician utilization of and experience with clinical pathways: (1) utility as a tool, (2) means of standardizing care, (3) reflection of institutional culture, and (4) element of the dynamic relationship with the clinician diagnostic process. These themes were generally common to both residents and attending physicians; however, some differences existed and are noted when they occurred. CONCLUSIONS Clinical pathways are part of many clinicians' diagnostic processes. Pathways can standardize care, influence the diagnostic process, and express local institutional culture. Further research is required to ascertain the optimal clinical pathway design to augment and not inhibit the clinician's diagnostic process.
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Affiliation(s)
- Yasaman Fatemi
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Pennsylvania, Philadelphia, USA
- Division of Infectious Diseases, Seattle Children's Hospital, Seattle, Washington, USA
| | - Anna Costello
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Pennsylvania, Philadelphia, USA
| | - Leora Lieberman
- Department of Pediatrics, The Children's Hospital of Philadelphia, Pennsylvania, Philadelphia, USA
| | - Jessica Hart
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Pennsylvania, Philadelphia, USA
| | - Kathy N Shaw
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Pennsylvania, Philadelphia, USA
| | - Judy A Shea
- Department of Internal Medicine, University of Pennsylvania, Pennsylvania, Philadelphia, USA
| | - Susan Coffin
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Pennsylvania, Philadelphia, USA
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Richards SD, Hayes M, Mazhani L, Arscott-Mills T, Mulale U, Coffin S, Steenhoff AP, Kitt E. Severity of illness and mortality among children admitted to a tertiary referral hospital in Botswana: A secondary data analysis of a prospective cohort study. SAGE Open Med 2023; 11:20503121221149356. [PMID: 36741934 PMCID: PMC9893097 DOI: 10.1177/20503121221149356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 12/16/2022] [Indexed: 02/01/2023] Open
Abstract
Objectives Data on triage practices of children admitted to Princess Marina Hospital in Gaborone, Botswana is limited. The inpatient triage, assessment, and treatment score was developed for low resource settings to predict mortality in children. We assess its performance among children admitted to Princess Marina Hospital and their demographic, clinical, and risk factors for death. Methods This was a secondary data analysis of a prospective cohort study comprising 299 children ages 1 month to 13 years admitted June to September 2018. Descriptive statistics, bivariate analysis, and multivariate logistic regression were used. Sensitivity and specificity data were generated for the inpatient triage, assessment, and treatment score. Results Thirteen children died (13/284, 4.6%). Comorbidity (adjusted odds ratio 4.0, p = 0.020) and high inpatient triage, assessment, and treatment score (adjusted odds ratio 5.0, p = 0.017) increased odds of death. The area under the receiver operating characteristic curve was 0.81. Using inpatient triage, assessment, and treatment cutoff of 4, the sensitivity, specificity, and likelihood ratio were 31%, 94%, and 5.0, respectively. Conclusion Implementing the inpatient triage, assessment, and treatment score in low resource settings may improve identification, treatment, and evaluation of the sickest children.
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Affiliation(s)
- Sheyla Denise Richards
- Department of Pediatrics, Stanford Children’s Health, Palo Alto, CA, USA,Division of Pediatric Critical Care, Lucile Salter Packard Children’s Hospital at Stanford, Palo Alto, CA, USA,Sheyla Richards, Lucile Packard Children’s Hospital at Stanford Pediatric Critical Care Medicine, 770 Welch Road, Suite 435, Mail Code 5876, Palo Alto, CA 94304-1601, USA.
| | - Molly Hayes
- Antimicrobial Stewardship Program, Children’s Hospital of Philadelphia, Philadelphia, PA, USAa
| | - Loeto Mazhani
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Tonya Arscott-Mills
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Botswana-UPenn Partnership, Gaborone, Botswana
| | - Unami Mulale
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Susan Coffin
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Andrew P Steenhoff
- Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Botswana-UPenn Partnership, Gaborone, Botswana,Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Eimear Kitt
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Schuster JE, Hamdan L, Dulek DE, Kitko CL, Batarseh E, Haddadin Z, Stewart LS, Stahl A, Potter M, Rahman H, Kalams SA, Coffin S, Ardura MI, Wattier RL, Maron G, Bocchini CE, Moulton EA, Grimley M, Paulsen G, Harrison CJ, Freedman J, Carpenter PA, Englund JA, Munoz FM, Danziger-Isakov L, Spieker AJ, Halasa N. Influenza Vaccine in Pediatric Recipients of Hematopoietic-Cell Transplants. N Engl J Med 2023; 388:374-376. [PMID: 36630610 DOI: 10.1056/nejmc2210825] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
| | - Lubna Hamdan
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | - Anna Stahl
- Vanderbilt University Medical Center, Nashville, TN
| | - Molly Potter
- Vanderbilt University Medical Center, Nashville, TN
| | - Herdi Rahman
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Susan Coffin
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Rachel L Wattier
- University of California, San Francisco, Benioff Children's Hospital-San Francisco, San Francisco, CA
| | | | | | | | - Michael Grimley
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Grant Paulsen
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Fatemi Y, Plaras M, Le Goff L, Handy L, Smathers S, Sammons JS, Coffin S, Kitt E. 2365. Fostering the Future: Improving Infection Prevention and Control Education in Pediatric Infectious Diseases Fellowship. Open Forum Infect Dis 2022. [PMCID: PMC9752388 DOI: 10.1093/ofid/ofac492.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Infection prevention and control (IPC) is a potential area of career specialization for infectious diseases (ID) fellows. However, ID fellows are not consistently involved in IPC operations or content expertise. IPC education for ID fellows at Children’s Hospital of Philadelphia relied upon lectures, self-study, and some in-person shadowing. ID fellows had few experiences engaging in surveillance, working with data, or discussing approaches to common clinical IPC scenarios. We aimed to develop an IPC curriculum for pediatric ID fellows focusing on experiential learning relevant to clinical and operational practice as an ID physician. Methods We used the Kern model to systematically design a curriculum addressing identified gaps in IPC education. Areas of need included: aligning IPC curriculum content with the physician role, improving tracking of core IPC experiences (e.g. surveillance, bedside reviews), incorporating education on IPC operations, and enhancing connection between ID fellows and IPC non-physician team members. We partnered an ID fellow and an IPC program manager to lead development of the new IPC curriculum. The designed curriculum consists of 3 weeks separated throughout fellowship focusing on: 1) IPC core concepts, and 2) IPC operational skills. Weeks 1 and 2 are a primer on IPC as a field including emphasis on the multidisciplinary roles involved. Week 3 focuses on the role of IPC within overall hospital operations. An optional 4th week is available for those pursuing a career in IPC. Results We have implemented 2 weeks of the new curriculum. The post-implementation feedback is still in progress as only 2 of the 3 weeks has been implemented. Initial feedback highlighted the interactive nature of the curriculum and organized delivery. Additionally, feedback from IPC team members highlighted the improved communication with fellows and better understanding of a fellow’s role. IPC Curriculum Overview An overview of the newly developed IPC curriculum for pediatric ID fellows. Week 1 and 2 are focused on IPC fundamentals, Week 3 is dedicated to operational knowledge and skill, and an optional week 4 exists for those particularly interested in IPC as a career. IPC Foundations "Passport" This is an example of the passport tool for tracking experiences during the IPC rotation weeks. This is used by both the fellow and the IPC division to help create shared awareness of a fellow's experiences and better identify any gaps. Key Elements of Operations Week. This schematic illustrates the key components of week 3 (Operations) of the IPC curriculum. The 3 main elements include collaborating on an IPC-related project, didactics of IPC emergencies (with opportunity to answer IPC calls with infection preventionists and IPC medical directors), and a focus operational skills essential to being a leader within IPC. Conclusion Through collaboration between the ID fellowship program and IPC, we redesigned the IPC curriculum for fellows. While implementation of the curriculum is still in progress with ongoing plans for evaluation, we have demonstrated success in engaging a multidisciplinary team to develop a curriculum for ID fellows focused on an operational (rather than strictly content) field. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
| | - Marisse Plaras
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lauren Le Goff
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lori Handy
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sarah Smathers
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julia S Sammons
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan Coffin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Kitt E, Hayes M, Congdon M, Ballester L, Sewawa KB, Mulale U, Mazhani L, Arscott-Mills T, Steenhoff A, Coffin S. Risk factors for mortality in a hospitalised neonatal cohort in Botswana. BMJ Open 2022; 12:e062776. [PMID: 36691117 PMCID: PMC9454043 DOI: 10.1136/bmjopen-2022-062776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/24/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES A disproportionate number of neonatal deaths occur in low/middle-income countries, with sepsis a leading contributor of mortality. In this study, we investigate risk factors for mortality in a cohort of high-risk hospitalised neonates in Botswana. Independent predictors for mortality for infants experiencing either a sepsis or a non-sepsis-related death are described. METHODS This is a prospective observational cohort study with infants enrolled from July to October 2018 at the neonatal unit (NNU) of Princess Marina Hospital (PMH) in Gaborone, Botswana. Data on demographic, clinical and unit-specific variables were obtained. Neonates were followed to death or discharge, including transfer to another hospital. Death was determined to be infectious versus non-infectious based on primary diagnosis listed on day of death by lead clinician on duty. RESULTS Our full cohort consisted of 229 patients. The overall death rate was 227 per 1000 live births, with cumulative proportion of deaths of 22.7% (n=47). Univariate analysis revealed that sepsis, extremely low birth weight (ELBW) status, hypoxic ischaemic encephalopathy, critical illness and infants born at home were associated with an increased risk of all-cause mortality. Our multivariate model revealed that critical illness (HR 3.07, 95% CI 1.56 to 6.03) and being born at home (HR 4.82, 95% CI 1.76 to 13.19) were independently associated with all-cause mortality. Low birth weight status was independently associated with a decreased risk of mortality (HR 0.24, 95% CI 0.11 to 0.53). There was a high burden of infection in the cohort with more than half of infants (140, 61.14%) diagnosed with sepsis at least once during their NNU admission. Approximately 20% (n=25) of infants with sepsis died before discharge. Our univariate subanalysis of the sepsis cohort revealed that ELBW and critical illness were associated with an increased risk of death. These findings persisted in the multivariate model with HR 3.60 (95% CI 1.11 to 11.71) and HR 2.39 (95% CI 1 to 5.77), respectively. CONCLUSIONS High rates of neonatal mortality were noted. Urgent interventions are needed to improve survival rates at PMH NNU and to prioritise care for critically ill infants at time of NNU admission, particularly those born at home and/or of ELBW.
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Affiliation(s)
- Eimear Kitt
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Molly Hayes
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Morgan Congdon
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Section of Hospital Medicine, CHOP, Philadelphia, Pennsylvania, USA
| | - Lance Ballester
- Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kgotlaetsile B Sewawa
- Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, South-East District, Botswana
| | - Unami Mulale
- Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, South-East District, Botswana
| | - Loeto Mazhani
- Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, South-East District, Botswana
| | - Tonya Arscott-Mills
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew Steenhoff
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan Coffin
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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6
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Mantadakis E, Kopsidas I, Coffin S, Dimitriou G, Gkentzi D, Hatzipantelis E, Kaisari A, Kattamis A, Kourkouni E, Papachristidou S, Papakonstantinou E, Polychronopoulou S, Roilides E, Spyridis N, Tsiodras S, Tsolia MN, Tsopela GC, Zaoutis T, Tragiannidis A. A national study of antibiotic use in Greek pediatric hematology oncology and bone marrow transplant units. Antimicrob Steward Healthc Epidemiol 2022; 2:e71. [PMID: 36483391 PMCID: PMC9726537 DOI: 10.1017/ash.2022.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE We surveyed antimicrobials used in Greek pediatric hematology-oncology (PHO) and bone marrow transplant (BMT) units before and after an intervention involving education regarding the 2017 clinical practice guidelines (CPG) for the management of febrile neutropenia in children with cancer and hematopoietic stem-cell transplant recipients. DESIGN Antibiotic prescribing practices were prospectively recorded between June 2016 and November 2017. INTERVENTION In December 2017, baseline data feedback was provided, and CPG education was provided. Prescribing practices were followed for one more year. For antibiotic stewardship, days of therapy, and length of therapy were calculated. SETTING Five of the 6 PHO units in Greece and the single pediatric BMT unit participated. PARTICIPANTS Admitted children in each unit who received the first 15 new antibiotic courses each month. RESULTS Administration of ≥4 antibiotics simultaneously and administration of antibiotics with overlapping activity for ≥2 days were significantly more common in PHO units in general hospitals compared to children's hospitals. Use of at least 1 antifungal was recorded in ∼47% of the patients before and after the intervention. De-escalation and/or discontinuation of antibiotics on day 6 of initial treatment increased significantly from 43% to 53.5% (P = .032). Although the number of patients requiring intensive care support for sepsis did not change, a significant drop was noted in all-cause mortality (P = .008). CONCLUSIONS We recorded the antibiotic prescribing practices in Greek PHO and BMT units, we achieved improved prescribing with a simple intervention, and we identified areas in need of improvement.
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Affiliation(s)
- Elpis Mantadakis
- Democritus University of Thrace Faculty of Medicine, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioannis Kopsidas
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Susan Coffin
- Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Gabriel Dimitriou
- Patras Medical School, University General Hospital of Patras, Patra, Greece
| | - Despoina Gkentzi
- Patras Medical School, University General Hospital of Patras, Patra, Greece
| | - Emmanouel Hatzipantelis
- Children & Adolescent Hematology–Oncology Unit, Second Pediatric Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Kaisari
- Stem Cell Transplant Unit, Aghia Sophia Children’s Hospital, Athens, Greece
| | - Antonis Kattamis
- First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, Athens, Greece
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | | | | | - Sophia Polychronopoulou
- Department of Pediatric Hematology–Oncology (T.A.O.), Aghia Sophia Children’s Hospital, Athens, Greece
| | - Emmanuel Roilides
- Third Department of Pediatrics, Aristotle University of Thessaloniki, Hipppokration General Hospital, Thessaloniki, Greece
| | - Nikos Spyridis
- Infectious Diseases Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Maria N. Tsolia
- Infectious Diseases Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | | | - Theoklis Zaoutis
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
- Infectious Diseases Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Athanasios Tragiannidis
- Children & Adolescent Hematology–Oncology Unit, Second Pediatric Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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7
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Kopsidas I, Molocha NM, Kourkouni E, Coffin S, Gkentzi D, Chorianopoulou E, Dimitriou G, Kapetanaki A, Karavana G, Lithoxopoulou M, Polychronaki M, Roilides E, Triantafyllidou P, Triantafyllou C, Tsopela GC, Tsouvala E, Tsolia MN, Zaoutis T, Spyridis N. Potential benefit from the implementation of the Kaiser Permanente neonatal early-onset sepsis calculator on clinical management of neonates with presumed sepsis. Eur J Pediatr 2022; 181:1001-1008. [PMID: 34664107 DOI: 10.1007/s00431-021-04282-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/15/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
To assess the potential benefit from the implementation of the Kaiser Permanente early-onset sepsis calculator (EOS-C), in terms of antibiotic use and requested laboratory tests, in a network of neonatal intensive care units (NICUs) in Greece, and to determine the incidence of early-onset sepsis (EOS) in Greek NICUs, a prospective surveillance study was conducted in 7 NICUs between April 2018 and June 2019. Data were collected for all newborns ≥ 34 weeks' gestation receiving empiric antibiotic therapy within the first 3 days of life. The number of live births and positive blood or cerebrospinal fluid cultures within the first 3 days of life were used for calculation of EOS incidence. Evaluation of possible impact of implementing the calculator was done by comparing the clinicians' recorded management to the calculator's suggested course of action. The unit-specific incidence of culture-proven EOS ranged between 0 and 2.99/1000 live births. The weighted incidence rate for all 7 units was 1.8/1000 live births. Management of EOS guided by the calculator could lead to a reduction of empiric antibiotic initiation up to 100% for the group of "well-appearing" neonates and 86% for "equivocal," lowering exposure to antibiotics by 4.2 and 3.8 days per neonate, respectively. Laboratory tests for blood cultures drawn could be reduced by up to 100% and 68%, respectively. Sensitivity of the EOS-C in identifying neonates with positive blood cultures was high.Conclusion: Management strategies based on the Kaiser Permanente neonatal sepsis calculator may significantly reduce antibiotic exposure, invasive diagnostic procedures, and hospitalizations in late preterm and term neonates. What is Known: • Neonates are frequently exposed to antibiotics for presumed EOS. • The Kaiser Permanente sepsis calculator can reduce antibiotic exposure in neonates.. What is New: • EOS calculator can be an effective antibiotic stewardship tool in a high prescribing country and can reduce invasive diagnostic procedures and mother-baby separation. • Incidence of EOS in Greece is higher compared to other European countries.
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Affiliation(s)
- Ioannis Kopsidas
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece.,Second Department of Pediatrics, National and Kapodistrian, University of Athens, School of Medicine, Athens, Greece
| | | | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Susan Coffin
- Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Despoina Gkentzi
- Department of Pediatrics, University General Hospital of Patras, Patras Medical School, Patras, Greece
| | | | - Gabriel Dimitriou
- Department of Pediatrics, University General Hospital of Patras, Patras Medical School, Patras, Greece
| | - Anastasia Kapetanaki
- Neonatal Intensive Care Unit, Elenas Venizelou Maternity Hospital, Athens, Greece
| | - Georgia Karavana
- Neonatal Intensive Care Unit, General Hospital of Nikaia and Piraeus "Aghios Panteleimon", Athens, Greece
| | - Maria Lithoxopoulou
- Second Department of Neonatology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Emmanuel Roilides
- Third Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | - Emmanouela Tsouvala
- Neonatal Intensive Care Unit, General University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Maria N Tsolia
- Second Department of Pediatrics, National and Kapodistrian, University of Athens, School of Medicine, Athens, Greece
| | - Theoklis Zaoutis
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece.,Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Nikos Spyridis
- Second Department of Pediatrics, National and Kapodistrian, University of Athens, School of Medicine, Athens, Greece.
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8
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Fitzgerald FC, Zingg W, Chimhini G, Chimhuya S, Wittmann S, Brotherton H, Olaru ID, Neal SR, Russell N, da Silva ARA, Sharland M, Seale AC, Cotton MF, Coffin S, Dramowski A. The Impact of Interventions to Prevent Neonatal Healthcare-associated Infections in Low- and Middle-income Countries: A Systematic Review. Pediatr Infect Dis J 2022; 41:S26-S35. [PMID: 35134037 PMCID: PMC8815829 DOI: 10.1097/inf.0000000000003320] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinically suspected and laboratory-confirmed bloodstream infections are frequent causes of morbidity and mortality during neonatal care. The most effective infection prevention and control interventions for neonates in low- and middle-income countries (LMIC) are unknown. AIM To identify effective interventions in the prevention of hospital-acquired bloodstream infections in LMIC neonatal units. METHODS Medline, PUBMED, the Cochrane Database of Systematic Reviews, EMBASE and PsychInfo (January 2003 to October 2020) were searched to identify studies reporting single or bundled interventions for prevention of bloodstream infections in LMIC neonatal units. RESULTS Our initial search identified 5206 articles; following application of filters, 27 publications met the inclusion and Integrated Quality Criteria for the Review of Multiple Study Designs assessment criteria and were summarized in the final analysis. No studies were carried out in low-income countries, only 1 in Sub-Saharan Africa and just 2 in multiple countries. Of the 18 single-intervention studies, most targeted skin (n = 4) and gastrointestinal mucosal integrity (n = 5). Whereas emollient therapy and lactoferrin achieved significant reductions in proven neonatal infection, glutamine and mixed probiotics showed no benefit. Chlorhexidine gluconate for cord care and kangaroo mother care reduced infection in individual single-center studies. Of the 9 studies evaluating bundles, most focused on prevention of device-associated infections and achieved significant reductions in catheter- and ventilator-associated infections. CONCLUSIONS There is a limited evidence base for the effectiveness of infection prevention and control interventions in LMIC neonatal units; bundled interventions targeting device-associated infections were most effective. More multisite studies with robust study designs are needed to inform infection prevention and control intervention strategies in low-resource neonatal units.
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Affiliation(s)
- Felicity C. Fitzgerald
- From the Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Walter Zingg
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gwendoline Chimhini
- Department of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Zimbabwe
| | - Simbarashe Chimhuya
- Department of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Zimbabwe
| | - Stefanie Wittmann
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Brotherton
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- MRC Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ioana D. Olaru
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Samuel R. Neal
- From the Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Neal Russell
- Paediatric Infectious Diseases Research Group, St George’s University of London, United Kingdom
| | - André Ricardo Araujo da Silva
- Laboratory of Teaching of Prevention and Control of Healthcare-Associated Infections, Federal Fluminense University, Brazil
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, St George’s University of London, United Kingdom
| | - Anna C. Seale
- From the Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mark F. Cotton
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Stellenbosch University, South Africa, and
| | - Susan Coffin
- Children’s Hospital of Philadelphia, Pennsylvania, Philadelphia
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Stellenbosch University, South Africa, and
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Dramowski A, Bekker A, Anugulruengkitt S, Bayani O, Martins Gonçalves F, Naizgi M, Magnino A, Puthanakit T, Salle F, da Silva ARA, Molyneux E, Strysko J, Vieira C, Coffin S. Keeping It Real: Infection Prevention and Control Problems and Solutions in Low- and Middle-income Countries. Pediatr Infect Dis J 2022; 41:S36-S39. [PMID: 35134038 PMCID: PMC8815840 DOI: 10.1097/inf.0000000000003319] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 11/26/2022]
Abstract
Infection prevention challenges are ubiquitous in healthcare, but some are unique to or more prevalent in low-and middle-income country settings. Despite limited resources, innovative and committed paediatric healthcare providers and infection preventionists have found creative solutions to address the very real and pressing risks their patients face every day. We gathered examples of infection prevention and control challenges faced by clinicians in resource-limited healthcare facilities, and the real-world infection prevention and control solutions they implemented, with the goal of learning broader lessons applicable to low-and middle-income countrie.
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Affiliation(s)
- Angela Dramowski
- Division of Paediatric Infectious Diseases and Division of Neonatology and
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Tygerberg Hospital, Cape Town, South Africa
| | - Suvaporn Anugulruengkitt
- Department of Paediatrics and
- Center of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - One Bayani
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana School of Medicine, Gaborone, Botswana
| | | | - Mulugeta Naizgi
- Paediatric & Child Health Department, Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | | | - Thanyawee Puthanakit
- Department of Paediatrics and
- Center of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Elizabeth Molyneux
- Paediatric and Child Health Department, College of Medicine, Blantyre, Malawi
| | | | | | - Susan Coffin
- Paediatric and Child Health Department, College of Medicine, Blantyre, Malawi
- Global Health Center and
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10
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Vurayai M, Strysko J, Kgomanyane K, Bayani O, Mokomane M, Machiya T, Arscott-Mills T, Goldfarb DM, Steenhoff AP, McGann C, Nakstad B, Gezmu A, Richard-Greenblatt M, Coffin S. Characterizing the bioburden of ESBL-producing organisms in a neonatal unit using chromogenic culture media: a feasible and efficient environmental sampling method. Antimicrob Resist Infect Control 2022; 11:14. [PMID: 35074019 PMCID: PMC8785036 DOI: 10.1186/s13756-021-01042-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/05/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Infections due to extended spectrum beta-lactamase producing organisms (ESBL) have emerged as the leading cause of sepsis among hospitalized neonates in Botswana and much of sub-Saharan Africa and south Asia. Yet, ESBL reservoirs and transmission dynamics within the neonatal intensive care unit (NICU) environment are not well-understood. This study aimed to assess the efficiency and feasibility of a chromogenic-culture-media-based environmental sampling approach to characterize the ESBL bioburden within a NICU. METHODS A series of four point-prevalence surveys were conducted at a 36-bed NICU at a public tertiary referral hospital in Botswana from January-June 2021. Samples were collected on 4 occasions under semi-sterile technique using 1) flocked swabs & templates (flat surfaces); 2) sterile syringe & tubing (water aspiration); and 3) structured swabbing techniques (hands & equipment). Swabs were transported in physiological saline-containing tubes, vortexed, and 10 µL was inoculated onto chromogenic-agar that was selective and differential for ESBL (CHROMagar™ ESBL, Paris, France), and streaking plates to isolate individual colonies. Bacterial colonies were quantified and phenotypically characterized using biochemical identification tests. RESULTS In total, 567 samples were collected, 248 (44%) of which grew ESBL. Dense and consistent ESBL contamination was detected in and around sinks and certain high-touch surfaces, while transient contamination was demonstrated on medical equipment, caregivers/healthcare worker hands, insects, and feeding stations (including formula powder). Results were available within 24-72 h of collection. To collect, plate, and analyse 50 samples, we estimated a total expenditure of $269.40 USD for materials and 13.5 cumulative work hours among all personnel. CONCLUSIONS Using basic environmental sampling and laboratory techniques aided by chromogenic culture media, we identified ESBL reservoirs (sinks) and plausible transmission vehicles (medical equipment, infant formula, hands of caregivers/healthcare workers, & insects) in this NICU environment. This strategy was a simple and cost-efficient method to assess ESBL bioburden and may be feasible for use in other settings to support ongoing infection control assessments and outbreak investigations.
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Affiliation(s)
- Moses Vurayai
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.
| | - Jonathan Strysko
- Department of Paediatric & Adolescent Health, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.,Global Health Center, Children's Hospital of Philadelphia, Philadelphia, USA.,Botswana-UPenn Partnership, Gaborone, Botswana
| | | | - One Bayani
- Department of Paediatric & Adolescent Health, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Margaret Mokomane
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | | | - Tonya Arscott-Mills
- Department of Paediatric & Adolescent Health, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.,Global Health Center, Children's Hospital of Philadelphia, Philadelphia, USA.,Botswana-UPenn Partnership, Gaborone, Botswana
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Andrew P Steenhoff
- Department of Paediatric & Adolescent Health, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.,Global Health Center, Children's Hospital of Philadelphia, Philadelphia, USA.,Botswana-UPenn Partnership, Gaborone, Botswana.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Carolyn McGann
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Britt Nakstad
- Department of Paediatric & Adolescent Health, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.,Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alemayehu Gezmu
- Department of Paediatric & Adolescent Health, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | | | - Susan Coffin
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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11
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Dramowski A, Aucamp M, Beales E, Bekker A, Cotton MF, Fitzgerald FC, Labi AK, Russell N, Strysko J, Whitelaw A, Coffin S. Healthcare-Associated Infection Prevention Interventions for Neonates in Resource-Limited Settings. Front Pediatr 2022; 10:919403. [PMID: 35874586 PMCID: PMC9301049 DOI: 10.3389/fped.2022.919403] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Healthcare-associated infections (HAIs) and antimicrobial-resistant (AMR) infections are leading causes of neonatal morbidity and mortality, contributing to an extended hospital stay and increased healthcare costs. Although the burden and impact of HAI/AMR in resource-limited neonatal units are substantial, there are few HAI/AMR prevention studies in these settings. We reviewed the mechanism of action and evidence supporting HAI/AMR prevention interventions, including care bundles, for hospitalized neonates in low- and middle-income countries (LMIC).
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Affiliation(s)
- Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marina Aucamp
- Infection Prevention and Control Service, Mowbray Maternity Hospital, Cape Town, South Africa
| | - Emily Beales
- Center for Neonatal and Pediatric Infection, St George's University of London, London, United Kingdom
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mark Frederic Cotton
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Felicity C Fitzgerald
- Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Appiah-Korang Labi
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Neal Russell
- Center for Neonatal and Pediatric Infection, St George's University of London, London, United Kingdom
| | - Jonathan Strysko
- Department of Paediatric and Adolescent Health, Princess Marina Hospital, Gaborone, Botswana.,Department of Global Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Andrew Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Susan Coffin
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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12
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Fatemi Y, Burns J, Polsky T, Nord E, Coffin S. 90. Deimplementation: Use of Electronic Clinical Decision Support to Reduce Unnecessary Erythrocyte Sedimentation Rate (ESR) Ordering. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In recent years, several de-implementation initiatives have focused on diagnostic testing. One such initiative, the Choosing Wisely campaign, recommends against routine use of erythrocyte sedimentation rate (ESR) for assessment of acute undiagnosed inflammation or infection. With the development of newer biomarkers of inflammation, particularly C-reactive protein (CRP), there is a decreasing role for ESR in screening for acute-onset conditions; however, ESR continues to be commonly ordered.
Methods
We examined ESR and CRP ordering practices at the Children’s Hospital of Philadelphia (CHOP) from July 2019 to July 2020 and found that 80% of ESR orders were placed concurrently with an order for CRP. We aimed to reduce ESR ordering by 20% at CHOP by using electronic clinical decision support in the form of embedded order guidance for ESR orders placed in the Emergency Department (ED) and inpatient setting. We examined the effect of the clinical decision support by assessing ESR ordering rate, defined by ESR orders per monthly patient days for the inpatient setting and ESR orders per monthly ED visits for the ED setting. We then examined differences in ordering rates using a quasi-experimental model with a concurrent control (basic metabolic panel).
ESR Electronic Clinical Decision Support Intervention
Inpatient and ED versions of the embedded electronic clinical decision support for ESR orders.
Results
Prior to implementation of the electronic decision support intervention, the median monthly rate of ESR orders was 13.6 per 1000 patient days and 70.3 per 1000 ED visits. During the initial month after implementation, we found that ESR ordering was 12.5 in inpatient and 46.4 in ED, reflecting decreased rates of ordering. The median monthly rate of basic metabolic panel orders (concurrent control) was 194.5 per 1000 patient days and 110.0 per 1000 ED visits. This was unchanged after intervention.
Conclusion
We conclude that electronic clinical decision support is a potentially effective deimplementation method for improving diagnostic test utilization, even with non-disease specific testing such as inflammatory markers. However, continued post-implementation data monitoring and analysis is needed to determine if this is a true difference and sustainable trend.
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
- Yasaman Fatemi
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julianne Burns
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tracey Polsky
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ellen Nord
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan Coffin
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Abstract
OBJECTIVES The COVID-19 pandemic has introduced strains in the diagnostic process through uncertainty in diagnosis, changes to usual clinical processes, and introduction of a unique social context of altered health care delivery and fear of the medical environment. These challenges created a context ripe for diagnostic error involving both systems and cognitive factors. CASE PRESENTATION We present a series of three pediatric cases presenting to care during the early phases of the COVID-19 pandemic that highlight the heightened potential for diagnostic errors in the pandemic context with particular focus on the interplay of systems and cognitive factors leading to delayed and missed diagnoses. These cases illustrate the particular power of availability bias, diagnostic momentum, and premature closure in the diagnostic process. CONCLUSIONS Through integrated commentary and a fishbone analysis of the cognitive and systems factors at play, these three cases emphasize the specific influence of the COVID-19 pandemic on pediatric patients.
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Affiliation(s)
- Yasaman Fatemi
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan Coffin
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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14
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Dramowski A, Bekker A, Cotton MF, Whitelaw AC, Coffin S. Epidemiology of clinically suspected and laboratory-confirmed bloodstream infections at a South African neonatal unit. J Infect Dev Ctries 2021; 15:943-952. [PMID: 34343119 DOI: 10.3855/jidc.13971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/03/2020] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Data from Africa reporting the epidemiology of infection in hospitalised neonates are limited. METHODOLOGY A prospective study with convenience sampling was conducted to characterise neonates investigated with blood culture/s for suspected infection at a 132-bed neonatal unit in Cape Town, South Africa (1 February-31 October 2018). Enrolled neonates were classified as having proven bloodstream infection (BSI) (blood culture-positive with a pathogen) or presumed infection (clinically suspected but blood culture-negative) or as potentially at risk of infection (maternal risk factors at birth). RESULTS Of 1299 hospitalised neonates with >1 blood culture sampling episode, 712 (55%) were enrolled: 126 (17.7%) had proven BSI; 299 (42%) had presumed infection and 287 (40.3%) were potentially at risk of infection. Neonates with proven BSI had lower birth weight and higher rates of co-existing surgical conditions versus the presumed/potential infection groups (p < 0.001). Median onset of proven BSI versus presumed infection was at 8 (IQR = 5-13) and 1 (IQR = 0-5) days respectively (p < 0.001). Most proven BSI were healthcare-associated (114/126; 90.5%), with Klebsiella pneumoniae (80.6% extended-spectrum β-lactamase producers) and Staphylococcus aureus (66.7% methicillin-resistant) predominating. Mortality from proven BSI (34/126; 27%) was substantially higher than that observed in presumed (8/299; 2.7%) and potential infections (3/287; 1.0%) (p < 0.001). The odds of death from proven BSI was 3-fold higher for Gram-negatives than for Gram-positive/fungal pathogens (OR = 3.23; 95% CI = 1.17-8.92). CONCLUSIONS Proven BSI episodes were predominantly healthcare-associated and associated with a high case fatality rate. Most neonates with presumed infection or at potential risk of infection had favourable 30-day outcomes.
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Affiliation(s)
- Angela Dramowski
- Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Adrie Bekker
- Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mark Frederic Cotton
- Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andrew Christopher Whitelaw
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Susan Coffin
- Division of Infectious Diseases, Children's Hospital of Philadelphia and Department of Paediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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15
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Rubin D, Eisen M, Collins S, Pennington JW, Wang X, Coffin S. SARS-CoV-2 Infection in Public School District Employees Following a District-Wide Vaccination Program - Philadelphia County, Pennsylvania, March 21-April 23, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1040-1043. [PMID: 34324479 PMCID: PMC8323551 DOI: 10.15585/mmwr.mm7030e1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The School District of Philadelphia reopened for in-school instruction the week of March 21, 2021, and required weekly testing for SARS-CoV-2, the virus that causes COVID-19, for all employees returning to in-school responsibilities. The resumption of in-school instruction followed a mass vaccination program using the Pfizer-BioNTech 2-dose vaccine offered under a partnership between the Philadelphia Department of Public Health and Children's Hospital of Philadelphia to all 22,808 School District of Philadelphia employees during February 23-April 3, 2021.* The subsequent mandatory testing program provided an opportunity to assess the percentage of positive BinaxNow point-of-care antigen tests (Abbott Laboratories) identified among school staff members based on their self-reported vaccination status (i.e., received zero, 1, or 2 vaccine doses) at the time of testing. During the initial 5 weeks after schools reopened, 34,048 screening tests were performed. Overall, 0.70% of tests returned a positive result. The percentage of positive test results was lower among persons who reported receipt of 2 vaccine doses (0.09%) compared with those who reported receipt of 1 dose (1.21%) or zero doses (1.76%) (p<0.001) representing a 95% reduction in percentage of positive SARS-CoV-2 test results among persons reporting receipt of 2 compared with zero doses of Pfizer-BioNTech vaccine. Vaccination of school staff members has been highlighted as an important strategy to maximize the safety of in-person education of K-12 students this fall (1). These findings reinforce the importance of promoting COVID-19 vaccination among school staff members before commencement of the 2021-22 school year.
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16
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Yee D, Osuka H, Weiss J, Kriengkauykiat J, Kolwaite A, Johnson J, Hopman J, Coffin S, Ram P, Serbanescu F, Park B. Identifying the priority infection prevention and control gaps contributing to neonatal healthcare-associated infections in low- and middle-income countries: results from a modified Delphi process. Journal of Global Health Reports 2021; 5. [PMID: 37179842 PMCID: PMC10174223 DOI: 10.29392/001c.21367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background In low- and middle-income countries (LMIC), neonatal healthcare-associated infections (HAI) are associated with increased morbidity, mortality, hospital stay, and costs. When resources are limited, addressing HAI through infection prevention and control (IPC) requires prioritizing interventions to maximize impact. However, little is known about the gaps in LMIC that contribute most to HAI. Methods A literature review was conducted to identify the leading IPC gaps contributing to neonatal HAIs in intensive care units and specialty care wards in LMIC. Additionally, a panel of 21 global experts in neonatology and IPC participated in an in-person modified Delphi process to achieve consensus on the relative importance of these gaps as contributors to HAI. Results Thirteen IPC gaps were identified and summarized into four main categories: facility policies such as prioritizing a patient safety culture and maintaining facility capacity, general healthcare worker behaviors such as hand hygiene and proper device insertion and maintenance, specialty healthcare worker behaviors such as cleaning and reprocessing of medical equipment, and infrastructural considerations such as adequate medical equipment and hand hygiene supplies. Conclusions Through a modified Delphi process, we identified the leading IPC gaps contributing to neonatal HAIs; this information can assist policymakers, public health officials, researchers, and clinicians to prioritize areas for further study or intervention.
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Affiliation(s)
- Daiva Yee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hanako Osuka
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Chenega Professional and Technical Services, Chesapeake, Virginia, USA
| | - Jamine Weiss
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Amy Kolwaite
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Joost Hopman
- Radboud University Medical Center, Nijmegen, Netherlands
| | - Susan Coffin
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Pavani Ram
- United States Agency for International Development, Washington, District of Columbia, USA
| | | | - Benjamin Park
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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17
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Affiliation(s)
- David Rubin
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Susan Coffin
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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18
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Henrickson S, O'Boyle K, Conrey P, Manne S, Bengsch B, Mentch F, Herati R, Qian T, Vella L, Pastore C, Hung LY, Sayed S, Herbert D, Masino A, Hensley S, Hakonarson H, Rabinowitz J, Coffin S, Wherry EJ. Mechanisms by which Obesity Dysregulates Immunometabolic State in Asthma. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Maritsi DN, Coffin S, Onoufriou M, Spyridis N, Tsolia MN. Decreased antibodies against rubella in previously vaccinated treatment-naïve childhood systemic lupus erythematous patients: a prospective case-control study. Scand J Rheumatol 2019; 48:74-76. [PMID: 29741129 DOI: 10.1080/03009742.2018.1446100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- D N Maritsi
- a Rheumatology and Infectious Diseases Unit, Second Department of Pediatrics, 'P and A Kyriakou' Children's Hospital, Medical School , National and Kapodestrian University of Athens , Athens , Greece.,b Rheumatology Unit , Archbishop Makarios III' Children's Hospital , Nicosia , Cyprus
| | - S Coffin
- c Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness and Department of Infection Prevention , Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - M Onoufriou
- b Rheumatology Unit , Archbishop Makarios III' Children's Hospital , Nicosia , Cyprus
| | - N Spyridis
- a Rheumatology and Infectious Diseases Unit, Second Department of Pediatrics, 'P and A Kyriakou' Children's Hospital, Medical School , National and Kapodestrian University of Athens , Athens , Greece
| | - M N Tsolia
- a Rheumatology and Infectious Diseases Unit, Second Department of Pediatrics, 'P and A Kyriakou' Children's Hospital, Medical School , National and Kapodestrian University of Athens , Athens , Greece
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20
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Downes K, Schriver E, Russo M, Weiss S, Fitzgerald J, Balamuth F, Tolomeo P, Bilker W, Han J, Lautenbach E, Coffin S, Gerber JS. Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study. Open Forum Infect Dis 2017. [PMCID: PMC5631187 DOI: 10.1093/ofid/ofx163.1305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Antibiotic overuse in the pediatric intensive care unit (PICU) is common and reliable approaches are needed to promote safe antibiotic discontinuation. In prior work we developed a biomarker-based algorithm that identified children with suspected sepsis at low risk of bacterial infection. We evaluated the effectiveness of this algorithm to reduce broad-spectrum antibiotic use in the PICU. Methods We conducted a quasi-experimental study focused on patients in whom antibiotics were initiated for presumed bacterial sepsis. Antibiotics were given per usual practice during the nonintervention period (T1: Aug 2012 – May 2015). From June 2015 – May 2016 (T2) PICU clinicians were encouraged but not required to stop antibiotics in “low-risk” patients: CRP <4 mg/dL and procalcitonin <1 ng/mL at SIRS onset (day 0) and no pathogen or signs of bacterial infection identified by day 2. The primary outcome was antibiotic length of therapy (LOT) from day 3 through 9, hospital discharge, or death. CDC NHSN definitions were used to define bacterial infections days 0–2. We reviewed all children ≤18 years with SIRS; those with immune compromise, DNR, or recent SIRS (within 30 days) were excluded. Time series analyses adjusting for significant covariates and confounders compared LOT from T1 to T2 in patients with no identified bacterial infection. We also calculated the incidence rate ratio (IRR) of LOT in the subset of patients who met our low-risk criteria. Results 525 eligible episodes of suspected sepsis occurred during T1 and 212 during T2. Bacterial infections were detected in 34% of T1 episodes and 39% in T2 (P = 0.16). Patients in T2 had fewer cardiovascular conditions but were otherwise similar to T1 patients. Broad-spectrum LOT remained unchanged in all patients without bacterial infections following implementation of our algorithm (OR 0.72, 95% CI 0.46 – 1.13; Figure 1). Among the subset who met low-risk criteria, LOT decreased from T1 to T2 (197 v. 104 antibiotic days per 1000 patient-days, IRR 0.53, 95% CI 0.30–0.93). Conclusion Implementation of a biomarker-based algorithm did not affect broad-spectrum antibiotic prescribing overall in patients without bacterial infections in our PICU, although LOT declined in those defined by our algorithm to be low-risk. Disclosures K. Downes, Merck, Inc.: Grant Investigator, Research grant; Pfizer, Inc.: Grant Investigator, Research grant
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Affiliation(s)
- Kevin Downes
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Emily Schriver
- Center for Pediatric Clinical Effectiveness, Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael Russo
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Scott Weiss
- Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julie Fitzgerald
- Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Fran Balamuth
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Warren Bilker
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer Han
- Division of Infectious Diseases, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ebbing Lautenbach
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Coffin
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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Chang C, Feemster KA, Coffin S, Handy LK. Treatment-Related Complications in Children Hospitalized With Disseminated Lyme Disease. J Pediatric Infect Dis Soc 2017; 6:e152-e154. [PMID: 28903521 PMCID: PMC5907847 DOI: 10.1093/jpids/pix060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/07/2017] [Indexed: 11/13/2022]
Abstract
We describe here treatment approaches and treatment-related complications in 138 hospitalized children with disseminated Lyme disease. The patients who received parenteral antibiotics had a higher rate of complications than those who received oral therapy (15.4 vs 4.2 per 1000 days of therapy, respectively; P < .05). Oral therapy should be used preferentially if either route is supported by current guidelines.
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Affiliation(s)
- Christine Chang
- Department of General Pediatrics, Children’s Hospital Los Angeles, California
| | - Kristen A Feemster
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania
| | - Susan Coffin
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania
| | - Lori K Handy
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Pennsylvania,Correspondence: L. K. Handy, MD, Division of Infectious Diseases, Nemours/Alfred I. duPont Hospital for Children, PO Box 269, Wilmington, DE 19899 ()
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22
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Sammons JS, Townsend S, Hoegg CL, Smathers SA, Graf EH, Coffin S, Williams KL, Farnon E, Nawab U, Munson D, Dysart K, Binenbaum G. Outbreak of Adenovirus in a Neonatal Intensive Care Unit: Rapid Detection and Successful Prevention of Secondary Transmission. Am J Infect Control 2017. [DOI: 10.1016/j.ajic.2017.04.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Williams R, Coffin S, Derryberry S, Djunaidi M, Shah A, Huang S, McGrane S, Cropsey C, Henson C, Costello W, Kennedy J, Haddad E, Danter M. The Influence of a Dedicated and Protocolized Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Strategy on Patient Outcomes: A Before and After Study. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Privette G, Satchell L, Smathers S, Coffin S, Sammons JS. Calling Out Gastrointestinal (GI) Illness: Surveillance and Response to GI Clusters in Healthcare Workers and Patients. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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Odeniyi F, Santos J, Hanley S, Faerber J, Localio R, Metlay J, Coffin S, Feemster K. Scratching the Surface: Detecting the Presence of Viral Pathogens in Pediatric Primary Care Clinics. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Hei H, Hoegg C, Smathers S, Coffin S, Sammons JS. A Multidimensional Quality Improvement Initiative to Reduce Pediatric Healthcare-Associated Respiratory Viral Infections. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hillary Hei
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cindy Hoegg
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sarah Smathers
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan Coffin
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julia Shaklee Sammons
- Perelman School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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27
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Sammons JS, Ross R, Ditaranto S, Gilman M, Reilly A, Kersun L, Shanahan A, Coffin S. Mucosal Barrier Injury Central Line-Associated Bloodstream Infections: What Is the Impact of Standard Prevention Bundles? Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Julia Shaklee Sammons
- Perelman School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachael Ross
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan Ditaranto
- Department of Medical/Medical Subspecialty Nursing, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Margaret Gilman
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anne Reilly
- Department of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Leslie Kersun
- Department of Inpatient Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amanda Shanahan
- Department of Inpatient Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan Coffin
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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28
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Odeniyi F, Szymczak JE, Metlay J, Coffin S, Feemster K. Exploring Clinic Characteristics and Opportunities for Hand Hygiene Among Parents and Patients in Pediatric Ambulatory Settings. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Folasade Odeniyi
- Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Joshua Metlay
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Susan Coffin
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristen Feemster
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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29
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Odeniyi F, Szymczak JE, Coffin S, Metlay J, Feemster K. Healthcare Worker (HCW) Perceptions of Healthcare-Associated Respiratory Infection in Pediatric Clinics: A Qualitative Study. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Folasade Odeniyi
- Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Susan Coffin
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joshua Metlay
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kristen Feemster
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Feemster K, Coffin S, Sastri N. Who Gets Treated for Influenza: Predictors of Antiviral Prescription Receipt Among Children With Outpatient Influenza-Like Illness. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kristen Feemster
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Infectious Diseases, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Vaccine Education Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan Coffin
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Natasha Sastri
- Master of Public Health Program, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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31
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Kelly B, Lautenbach E, Nachamkin I, Coffin S, Gerber JS, Fuchs B, Garrigan C, Han X, Bilker W, Wise J, Tolomeo P, Han, J. Combined Biomarkers Discriminate Mortality Risk Among Critically Ill Patients With Suspected Sepsis. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Brendan Kelly
- Centers for Disease Control and Prevention Prevention Epicenters Program
| | - Ebbing Lautenbach
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Irving Nachamkin
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Susan Coffin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jeffrey S. Gerber
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Barry Fuchs
- Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Charles Garrigan
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Xiaoyan Han
- Division of Pulmonary Medicine and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Warren Bilker
- Division of Pulmonary Medicine and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jacqueleen Wise
- Division of Pulmonary Medicine and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Pam Tolomeo
- Division of Pulmonary Medicine and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer Han,
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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32
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Dimopoulou A, Kourlaba G, Psarris A, Coffin S, Spoulou V, Zaoutis T. Perioperative antimicrobial prophylaxis in pediatric patients in Greece: Compliance with guidelines and impact of an educational intervention. J Pediatr Surg 2016; 51:1307-11. [PMID: 26711690 DOI: 10.1016/j.jpedsurg.2015.11.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 11/03/2015] [Accepted: 11/22/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Appropriate antimicrobial prophylaxis (PAP) prevents surgical site infections (SSI). The aim of this study was to evaluate the effectiveness of an educational intervention to improve adherence to PAP guidelines in pediatric patients. METHODS A three-phase prospective study with a pre-post design was conducted from April 2013 to December 2014. All patients who underwent one or more surgical procedures were enrolled. A modified Centers for Disease Control's (CDC) Denominator for Procedure form was used to collect clinical and PAP data. The educational intervention was targeted at all pediatric surgeons in the department. Outcomes assessed were the appropriateness of the agent selected for PAP (according to international guidelines) and appropriate termination of PAP within 24h of surgery completion. SSI rates were calculated before and after the intervention. RESULTS During the study period 889 children were enrolled (219 in the preintervention and 670 in the postintervention period). The percentage of patients receiving appropriate PAP improved from 6.2% to 77.1% after the educational intervention (p<0.001). The median duration of PAP was reduced from 5 to 1days in preintervention and postintervention period, respectively. There was no increase in the rate of SSIs (0.93% and 0.92%, p=0.992, in preinterventionand postintervention, respectively). CONCLUSIONS An educational intervention targeted at pediatric surgeons improved the selection of agent and timely discontinuation of PAP.
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Affiliation(s)
- Anastasia Dimopoulou
- Department of Pediatric Surgery, "Aghia Sophia" Children's Hospital, Athens, Greece.
| | - Georgia Kourlaba
- The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece
| | - Alexandros Psarris
- Department of Pediatric Surgery, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Susan Coffin
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Philadelphia, PA, USA
| | - Vasiliki Spoulou
- National Kapodistrian University, Athens, Greece; First Department of Pediatrics, Aghia Sophia" Children's Hospital, Athens, Greece
| | - Theoklis Zaoutis
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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33
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Dimopoulou A, Papanikolaou Z, Kourlaba G, Kopsidas I, Coffin S, Zaoutis T. Surgical Site Infections and Compliance with Perioperative Antimicrobial Prophylaxis in Greek Children. Infect Control Hosp Epidemiol 2016; 35:1425-7. [DOI: 10.1086/678411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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34
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Cocoros NM, Kleinman K, Priebe GP, Gray JE, Logan LK, Larsen G, Sammons J, Toltzis P, Miroshnik I, Horan K, Burton M, Sims S, Harper M, Coffin S, Sandora TJ, Hocevar SN, Checchia PA, Klompas M, Lee GM. Ventilator-Associated Events in Neonates and Children--A New Paradigm. Crit Care Med 2016; 44:14-22. [PMID: 26524075 PMCID: PMC10884951 DOI: 10.1097/ccm.0000000000001372] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify a pediatric ventilator-associated condition definition for use in neonates and children by exploring whether potential ventilator-associated condition definitions identify patients with worse outcomes. DESIGN Retrospective cohort study and a matched cohort analysis. SETTING Pediatric, cardiac, and neonatal ICUs in five U.S. hospitals. PATIENTS Children 18 years old or younger ventilated for at least 1 day. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We evaluated the evidence of worsening oxygenation via a range of thresholds for increases in daily minimum fraction of inspired oxygen (by 0.20, 0.25, and 0.30) and daily minimum mean airway pressure (by 4, 5, 6, and 7 cm H2O). We required worsening oxygenation be sustained for at least 2 days after at least 2 days of stability. We matched patients with a ventilator-associated condition to those without and used Cox proportional hazard models with frailties to examine associations with hospital mortality, hospital and ICU length of stay, and duration of ventilation. The cohort included 8,862 children with 10,209 hospitalizations and 77,751 ventilator days. For the fraction of inspired oxygen 0.25/mean airway pressure 4 definition (i.e., increase in minimum daily fraction of inspired oxygen by 0.25 or mean airway pressure by 4), rates ranged from 2.9 to 3.2 per 1,000 ventilator days depending on ICU type; the fraction of inspired oxygen 0.30/mean airway pressure 7 definition yielded ventilator-associated condition rates of 1.1-1.3 per 1,000 ventilator days. All definitions were significantly associated with greater risk of hospital death, with hazard ratios ranging from 1.6 (95% CI, 0.7-3.4) to 6.8 (2.9-16.0), depending on thresholds and ICU type. Each definition was associated with prolonged hospitalization, time in ICU, and duration of ventilation, among survivors. The advisory board of the study proposed using the fraction of inspired oxygen 0.25/mean airway pressure 4 thresholds to identify pediatric ventilator-associated conditions in ICUs. CONCLUSIONS Pediatric patients with ventilator-associated conditions are at substantially higher risk for mortality and morbidity across ICUs, regardless of thresholds used. Next steps include identification of risk factors, etiologies, and preventative measures for pediatric ventilator-associated conditions.
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Affiliation(s)
- Noelle M Cocoros
- 1Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.2Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA.3Department of Neonatology, Beth Israel Deaconess Medical Center, Boston MA.4Department of Pediatrics, Section of Pediatric Infectious Diseases, Rush University Medical Center, Chicago, IL.5Department of Pediatrics, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT.6Department of Pediatrics, Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania and Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA.7Division of Pediatric Critical Care, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.8Department of Information Services, Rush University Medical Center, Chicago, IL.9Department of Medicine, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA.10Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA.11Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.12Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
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Han J, Nachamkin I, Coffin S, Gerber JS, Garrigan C, Han X, Bilker W, Wise J, Tolomeo P, Lautenbach E. Use of a Combination Biomarker Algorithm to Identify Critically Ill Surgical Patients With Suspected Sepsis at Very Low Likelihood of Bacterial Infection. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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36
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Ross R, Canning D, Coffin S, Gerber JS. Patterns of Perioperative Antibiotic Use After Ambulatory Surgery in Ambulatory Surgical Centers Versus a Hospital-Based Facility. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Downes K, Weiss S, Klieger SB, Fitzgerald J, Balamuth F, Kubis S, Tolomeo P, Bilker W, Han X, Nachamkin I, Garrigan C, Han J, Lautenbach E, Gerber JS, Coffin S. Developing a Biomarker-Driven Algorithm to Improve Antibiotic Use in the Pediatric Intensive Care Unit: The Optimizing Antibiotic Strategies in Sepsis (OASIS) Study. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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38
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Chang C, Feemster K, Coffin S, Handy L. Treatment-Related Complications in Children With Disseminated Lyme Disease. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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39
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Han J, Nachamkin I, Coffin S, Gerber JS, Fuchs B, Garrigan C, Han X, Bilker W, Wise J, Tolomeo P, Lautenbach E. Use of a Combination Biomarker Algorithm to Identify Intensive Care Unit Patients With Suspected Sepsis at Very Low Likelihood of Bacterial Infection. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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40
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Feemster K, Vendetti N, Coffin S. Who Gets Tested for Influenza: Exploring Socioeconomic Disparities in Influenza Testing Practices for Children in Pediatric Clinics. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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41
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Cocoros N, Sandora TJ, Logan LK, Coffin S, Priebe GP, Sammons JS, Larsen G, Toltzis P, Horan K, Miroshnik I, Burton M, Checchia PA, Klompas M, Lee G. Infection-Related Ventilator-Associated Complications (iVAC) in Neonates and Children: Can We Identify It? Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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42
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Odeniyi F, Szymczak JE, Coffin S, Feemster K. Parent Perceptions of Healthcare-Associated Respiratory Infection in Pediatric Clinics: A Qualitative Study. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Marlowe L, Mistry RD, Coffin S, Leckerman KH, McGowan KL, Dai D, Bell LM, Zaoutis T. Blood Culture Contamination Rates after Skin Antisepsis with Chlorhexidine Gluconate versus Povidone-Iodine in a Pediatric Emergency Department. Infect Control Hosp Epidemiol 2015; 31:171-6. [DOI: 10.1086/650201] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective.To determine blood culture contamination rates after skin antisepsis with Chlorhexidine, compared with povidone-iodine.Design.Retrospective, quasi-experimental study.Setting.Emergency department of a tertiary care children's hospital.Patients.Children aged 2-36 months with peripheral blood culture results from February 2004 to June 2008. Control patients were children younger than 2 months with peripheral blood culture results.Methods.Blood culture contamination rates were compared using segmented regression analysis of time-series data among 3 patient groups: (1) patients aged 2-36 months during the 26-month preintervention period, in which 10% povidone-iodine was used for skin antisepsis before blood culture; (2) patients aged 2-36 months during the 26-month postintervention period, in which 3% Chlorhexidine gluconate was used; and (3) patients younger than 2 months not exposed to the Chlorhexidine intervention (ie, the control group).Results.Results from 11,595 eligible blood cultures were reviewed (4,942 from the preintervention group, 4,274 from the postintervention group, and 2,379 from the control group). For children aged 2-36 months, the blood culture contamination rate decreased from 24.81 to 17.19 contaminated cultures per 1,000 cultures (P< .05) after implementation of Chlorhexidine. This decrease of 7.62 contaminated cultures per 1,000 cultures (95% confidence interval, —0.781 to —15.16) represented a 30% relative decrease from the preintervention period and was sustained over the entire postintervention period. No change in contamination rate was observed in the control group (P= .337).Conclusion.Skin antisepsis with Chlorhexidine significantly reduces the blood culture contamination rate among young children, as compared with povidone-iodine.
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Wilson K, Smathers S, Teszner E, Farrell L, Cohen D, Schleelein L, Coffin S, Sammons JS. Improving Hand Hygiene in a Pediatric Operative Environment. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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45
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See I, Chang J, Gualandi N, Buser GL, Rohrbach P, Smeltz D, Bellush MJ, Coffin S, Gould JM, Hennessey P, Hess D, Hubbard S, Kiernan A, O'donnell J, Pegues D, Miller JR, Magill SS. 894Evaluating Clinical Credibility of Surveillance Definitions for Healthcare-Associated Pneumonia and Lower Respiratory Infections. Open Forum Infect Dis 2014. [PMCID: PMC5781482 DOI: 10.1093/ofid/ofu052.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Isaac See
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Julia Chang
- UCLA Geffen School of Medicine, Los Angeles, CA
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Genevieve L. Buser
- Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, OR
| | | | - Debra Smeltz
- Pennsylvania Department of Health, Harrisburg, PA
| | | | - Susan Coffin
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jane M. Gould
- St. Christopher's Hospital for Children, Philadelphia, PA
| | | | - Debra Hess
- Lancaster General Hospital, Lancaster, PA
| | - Sydney Hubbard
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Andrea Kiernan
- St. Christopher's Hospital for Children, Philadelphia, PA
| | | | - David Pegues
- University of Pennsylvania Health System, Philadelphia, PA
| | - Jeffrey R. Miller
- Career Epidemiology Field Officer, Office of Public Health Preparedness and Response, CDC, assigned to the Pennsylvania Department of Health, Harrisburgh, PA
| | - Shelley S. Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Tribble A, Coffin S, Campos D, Feemster K. 1413Factors Associated with Pertussis Testing: Potential Disparities in Case Ascertainment. Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu052.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alison Tribble
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Susan Coffin
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Diego Campos
- Center for Biomedical Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kristen Feemster
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
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Mougkou K, Kouni S, Kurlaba G, Kitra M, Gkentzi D, Maroudi-Manta S, Lourida A, Coffin S, Zaoutis T. P218: Active surveillance for central line associated bloodstream infections in hospitalized children in Greece. Antimicrob Resist Infect Control 2013. [PMCID: PMC3688088 DOI: 10.1186/2047-2994-2-s1-p218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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48
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Kouni S, Mougkou K, Kurlaba G, Nteli C, Lourida A, Maroudi-Manta S, Zaoutis T, Coffin S. P130: Assessment of hand hygiene practices at the two children's hospitals in Greece. Antimicrob Resist Infect Control 2013. [PMCID: PMC3687970 DOI: 10.1186/2047-2994-2-s1-p130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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49
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Thu TA, Rahman M, Coffin S, Harun-Or-Rashid M, Sakamoto J, Hung NV. Antibiotic use in Vietnamese hospitals: a multicenter point-prevalence study. Am J Infect Control 2012; 40:840-4. [PMID: 22341530 DOI: 10.1016/j.ajic.2011.10.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 10/28/2011] [Accepted: 10/28/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inappropriate antibiotic prescribing appears to be common worldwide and is contributing to the selection of resistant organisms. This study examined the prevalence of antibiotic prescription and the appropriateness of indications for these prescriptions in 36 representative general hospitals across Vietnam. METHODS A point-prevalence study was performed between February and December 2008. All inpatients on the day of the survey were included in the analysis. Standard published guidelines were used to evaluate the appropriateness of indications for antibiotic prescription. RESULTS On the day of the study, 5,104 of 7,571 patients (67.4%) were receiving antibiotic therapy. The antibiotic prescription rate was highest in surgery wards (93.2%) and lowest in medical wards (48.2%). Of the 5,104 patients receiving antibiotics, the most commonly prescribed agents were cephalosporins (70.2%), penicillins (21.6%), and aminoglycosides (18.9%). Approximately one-third of the patients (1,573 of 5,104) had an inappropriate indication for prescription. Risk factors independently associated with inappropriate indication for antibiotic prescription were seen in hospitals at the national level, obstetrics and gynecology departments, and surgical wards. CONCLUSIONS Our data indicate a high rate of antibiotic use in Vietnamese hospitals, and also a high prevalence of inappropriate indications for antibiotic prescriptions. These findings suggest important areas for intervention and implementation of antibiotic stewardship policies in Vietnamese hospitals.
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Affiliation(s)
- Truong Anh Thu
- Nagoya University Graduate School of Medicine, Young Leaders' Program in Healthcare Administration, Nagoya, Japan.
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50
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Smathers S, Smathers SA, Hoegg CL, Sherman E, Brittingham L, Evans JR, Coffin S. Control of MRSA Colonization in a Teritiary NICU. Am J Infect Control 2012. [DOI: 10.1016/j.ajic.2012.04.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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