Use of a Clinical Care Algorithm to Improve Care for Children With Hematogenous Osteomyelitis.

Background And Objectives: Acute hematogenous osteomyelitis (AHO) causes significant morbidity in children. Quality improvement (QI) methods have been used to successfully improve care and decrease costs through standardization for numerous conditions, including pediatric AHO. We embarked on a QI initiative to standardize our approach to the inpatient management of AHO, with a global aim of reducing inpatient costs.

Association of visitation policy and health care-acquired respiratory viral infections in hospitalized children.

Visitor restriction policies are meant to prevent health care-acquired viral infections; however, data on their efficacy in hospitalized children are limited. We report a 37% reduction in health care-acquired respiratory viral infections in a children's hospital following standardization of the visitation policy that limited the number of visitors during a patient's hospitalization.

Coughing, sneezing, and aching online: Twitter and the volume of influenza-like illness in a pediatric hospital.

This study investigates the relation of the incidence of georeferenced tweets related to respiratory illness to the incidence of influenza-like illness (ILI) in the emergency department (ED) and urgent care clinics (UCCs) of a large pediatric hospital. We collected (1) tweets in English originating in our hospital's primary service area between 11/1/2014 and 5/1/2015 and containing one or more specific terms related to respiratory illness and (2) the daily number of patients presenting to our hospital's EDs and UCCs with ILI, as captured by ICD-9 codes. A Support Vector Machine classifier was applied to the set of tweets to remove those unlikely to be related to ILI.

Enterovirus D68 Infection Among Children With Medically Attended Acute Respiratory Illness, Cincinnati, Ohio, July-October 2014.

Background: Enterovirus D68 (EV-D68) caused a widespread outbreak of respiratory illness in the United States in 2014, predominantly affecting children. We describe EV-D68 rates, spectrum of illness, and risk factors from prospective, population-based acute respiratory illness (ARI) surveillance at a large US pediatric hospital.

Methods: Children <13 years of age with ARI and residence in Hamilton County, Ohio were enrolled from the inpatient and emergency department (ED) settings at a children's hospital in Cincinnati, Ohio, from 1 July to 31 October 2014.

Healthcare Burden, Risk Factors, and Outcomes of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections after Stem Cell Transplantation.

Mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs) lead to significant morbidity, mortality, and healthcare resource utilization in hematopoietic stem cell transplant (HSCT) patients. Determination of the healthcare burden of MBI-LCBIs and identification of patients at risk of MBI-LCBIs will allow researchers to identify strategies to reduce MBI-LCBI rates. The objective of our study was to describe the incidence, risk factors, timing, and outcomes of MBI-LCBIs in hematopoietic stem cell transplant patients.

Utilizing improvement science methods to improve physician compliance with proper hand hygiene.

Objective: In 2009, The Joint Commission challenged hospitals to reduce the risk of health care-associated infections through hand hygiene compliance. At our hospital, physicians had lower compliance rates than other health care workers, just 68% on general pediatric units. We used improvement methods and reliability science to increase compliance with proper hand hygiene to >95% by inpatient general pediatric teams.

A hospital-wide quality-improvement collaborative to reduce catheter-associated bloodstream infections.

Background: Catheter-associated bloodstream infections (CA BSIs) are associated with increased hospital length of stay, total hospital costs, and mortality. Quality-improvement collaboratives (QICs) are frequently used to improve health care quality. Our PICU was previously involved in a successful national QIC to reduce the incidence of CA BSI in critically ill children.

Quality-improvement initiative sustains improvement in pediatric health care worker hand hygiene.

Objective: To use quality-improvement (QI) methods to develop and test a multimodal intervention to improve hand-hygiene compliance among health care workers (HCWs) to >90%.

Methods: We used a quasi-experimental staggered intervention that was conducted on 2 similar general pediatric units within a 475-bed tertiary children's hospital. Compliance was defined as acceptable hand hygiene both before and after contact with the patient or the patient's care environment.

Estimating the rotavirus hospitalization disease burden and trends, using capture-recapture methods.

Background: Rotavirus surveillance is needed to provide estimates of disease burden and to evaluate the effect of vaccination programs. Our objective was to use capture-recapture methods to estimate rotavirus hospitalization rates and to examine trends over time.

Methods: Children <3 years of age residing in Hamilton County, Ohio hospitalized with acute gastroenteritis, and laboratory-confirmed rotavirus between 1997 and 2008 were identified through 2 independent surveillance systems: an active system with prospective enrollment of children admitted with acute gastroenteritis and a passive system of children identified by rotavirus testing as part of their usual medical care.

Controversies in vaccine mandates.

Policies that mandate immunization have always been controversial. The controversies take different forms in different contexts. For routine childhood immunizations, many parents have fears about both short- and long-term side effects.

Reducing surgical site infections at a pediatric academic medical center.

Background: Surgical site infections (SSIs) remain a substantial cause of morbidity, mortality, increased length of stay, and increased hospital costs. Cincinnati Children's Hospital Medical Center (CCHMC) used reliability science to dramatically reduce the rate of surgical site infections.

Methods: Key activities included the development and implementation of strategies to enhance the proportion of patients who receive timely antibiotic administration, a pediatric surgical site infection-prevention bundle, and procedure-specific pediatric surgical site infection-prevention bundles.

Risk factors associated with surgical site infection after pediatric posterior spinal fusion procedure.

Objective: To identify risk factors associated with surgical site infection (SSI) after pediatric posterior spinal fusion procedure by examining characteristics related to the patient, the surgical procedure, and tissue hypoxia.

Design: Retrospective case-control study nested in a hospital cohort study.

Setting: A 475-bed, tertiary care children's hospital.

Characterization of serological responses to pertussis.

We have compared the use of five nonvaccine antigens to the use of conventional vaccine antigens, pertussis toxin (PT), and filamentous hemagglutinin (FHA) for the serological diagnosis of pertussis by enzyme-linked immunosorbent assay (ELISA). The nonvaccine antigens included the catalytic region of adenylate cyclase toxin (CatACT), the C-terminal region of FHA (C-FHA), lipooligosaccharide (LOS), the peptidoglycan-associated lipoprotein (PAL), and the BrkA protein. The serological responses of individuals with culture-confirmed pertussis were compared to those of adults with no recent history of a coughing disease.

Atypical Mycobacterium furunculosis occurring after pedicures.

Mycobacterium fortuitum complex are rapidly-growing nontuberculous mycobacteria found ubiquitously in the environment including, water, soil, dust, and biofilms. M fortuitum has been reported to cause skin and soft-tissue infections in association with nail salon footbath use during pedicures. Four cases of M fortuitum complex furunculosis are reported that occurred after pedicures in the Cincinnati, Ohio/Northern Kentucky area.

Pertussis vaccine effectiveness among children 6 to 59 months of age in the United States, 1998-2001.

Background: Despite the dramatic pertussis decrease since the licensure of whole-cell pertussis (diphtheria-tetanus toxoids-pertussis [DTP]) vaccines in the middle 1940s, pertussis remains endemic in the United States and can cause illness among persons at any age; >11000 pertussis cases were reported in 2003. Since July 1996, in addition to 2 DTP vaccines already in use, 5 acellular pertussis (diphtheria-tetanus toxoids-acellular pertussis [DTaP]) vaccines were licensed for use among infants; 3 DTaP vaccines were distributed widely during the study period. Because of the availability of 3 DTaP and 2 DTP vaccines and the likelihood of the vaccines being used interchangeably to vaccinate children with the recommended 5-dose schedule, measuring the effectiveness of the pertussis vaccines was a high priority.

Herpes zoster in the first year of life following postnatal exposure to varicella-zoster virus: four case reports and a review of infantile herpes zoster.

Background: Herpes zoster, a painful vesicular dermatomal eruption, is the result of reactivation of the varicella-zoster virus (VZV) from infected sensory ganglia. Traditionally, it is considered to be a disease of adults, in contrast to primary infection with VZV, which tends to occur mainly in children.

Observations: We report 4 cases of infantile herpes zoster in healthy immunocompetent children, all of whom were exposed to primary varicella infection within the first few months of life.

Antibody-mediated neutralization of pertussis toxin-induced mitogenicity of human peripheral blood mononuclear cells.

Antibody-mediated neutralization of pertussis toxin-induced proliferation of human peripheral blood mononuclear cells (PBMC) was assessed using alamarBlue and compared with results from the Chinese hamster ovary (CHO) cell assay using sera from vaccinated adults and convalescent children. Neutralization values for the CHO assay were similar for vaccinated and convalescent subjects; however. the convalescent group had higher titers in the PBMC assay.

Phagocytosis of Bordetella pertussis incubated with convalescent serum.

Convalescent serum samples were examined for the ability to promote phagocytosis of Bordetella pertussis by human neutrophils. One sample promoted phagocytosis, and 11 of the 51 samples caused a statistically significant reduction in phagocytosis, compared with that of bacteria not incubated with serum. Phagocytosis was influenced by interactions between antibodies that promoted phagocytosis and antibodies that inhibited phagocytosis.

Screening for neonatal herpes: physicians' descriptions of discussions with parents.

Screening for possible herpes simplex virus infection in neonates may raise feelings of anxiety and distress among parents and physicians. To elicit physicians' experiences of communicating with families when screening for neonatal herpes, we conducted a series of semi-structured interviews with 15 physicians from one paediatric institution, and coded the resulting audiotapes for common themes. These included how physicians prepared families for screening and treatment, how physicians managed stigma, and perceived parental reactions.