Levofloxacin prophylaxis in pediatric oncology and hematopoietic stem cell transplantation: a literature review.

Bloodstream infections (BSI) are one of the leading causes of morbidity and mortality in children and young adults receiving chemotherapy for malignancy or undergoing hematopoietic stem cell transplantation (HSCT). Antibiotic prophylaxis is commonly used to decrease the risk of BSI; however, antibiotics carry an inherent risk of complications. The aim of this manuscript is to review levofloxacin prophylaxis in pediatric oncology patients and HSCT recipients.

bloodstream infections genetically related to probiotic use in pediatric hematopoietic cell transplant patients.

We describe a cluster of 6 pediatric hematopoietic cell transplant recipients with bacteremia attributed to probiotic use. isolates cultured from probiotics and patients' blood were proven to be related using whole-genome sequencing. Clinical studies are needed to evaluate the safety of probiotic use in immunocompromised patients.

Improving visitors' hand hygiene compliance in a pediatric oncology unit.

Background: Hand hygiene (HH) is the single most important method to prevent infections. We aim at improving HH compliance by visitors to a pediatric oncology unit.

Methods: A performance improvement project implemented several Plan-Do-Study-Act cycles in July-November 2018.

Effect of a shielded continuous ultraviolet-C air disinfection device on reduction of air and surface microbial contamination in a pediatric oncology outpatient care unit.

Background: For a clean hospital environment, we evaluated whether ultraviolet-C (UV-C) air disinfection reduces airborne and surface microbial contamination in an outpatient pediatric oncology center.

Methods: A pre- and post-intervention study compared 6 test locations, where continuous shielded UV-C air disinfection devices were installed, with 10 control locations without UV-C. Pre- and post-intervention air and surface samples were collected for bacterial and fungal cultures.

Leadership line care rounds: Application of the engage, educate, execute, and evaluate improvement model for the prevention of central line-associated bloodstream infections in children with cancer.

To prevent central line-associated bloodstream infections (CLABSIs), leadership line care rounds (LLCRs) used the engage, educate, execute, and evaluate improvement model to audit compliance, identify barriers and opportunities, empower patients and families, and engage leadership. Findings of excellence and improvement opportunities were communicated to unit staff and managers. LLCRs contributed to compliance with CLABSI prevention interventions.

Impact of a Successful Speaking Up Program on Health-Care Worker Hand Hygiene Behavior.

Background: Health-care worker (HCW) hand hygiene (HH) is the cornerstone of efforts to reduce hospital infections but remains low. Real-time mitigation of failures can increase process reliability to > 95% but has been challenging to implement for HH.

Objective: To sustainably improve HCW HH to > 95%.

Successful development of a direct observation program to measure health care worker hand hygiene using multiple trained volunteers.

Background: Direct observation of health care worker (HCW) hand hygiene (HH) remains the gold standard, but implementation is challenging. Our objective was to develop an accurate HH observation program using multiple HCW volunteers.

Methods: HH compliance was defined as correct HH performed before and after contact with a patient or a patient's environment.

Parental perceptions about required influenza immunization of pediatric healthcare personnel.

Annual influenza vaccination is recommended for all healthcare personnel (HCP). During 2010-2011, a cross-sectional design was used to survey 372 parents of hospitalized children regarding their influenza vaccination perceptions. Independent of their feelings regarding vaccine safety and efficacy, 76% of parents felt that annual influenza vaccination should be required for HCP.

Introduction of a rounding sticker improves care and reduces infection rates in the Pediatric Intensive Care Unit (PICU).

As part of our plan to decrease infection rates, we instituted a rounding sticker used during daily rounds. This sticker is a checklist that serves as a reminder of interventions known to improve quality of care in the PICU. It is completed daily and placed in the bedside chart of all patients in the Pediatric Intensive Care Unit (PICU) at Arkansas Children's Hospital.

Prevention of central venous catheter-associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative.

Objective: The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention.

Methods: An observational study was conducted in 26 freestanding children's hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative. CVC-associated BSI protocols were implemented using a collaborative process that included catheter insertion and maintenance bundles, daily review of CVC necessity, and daily goals.

Catheter-associated bloodstream infections in the NICU: getting to zero.

The neonatal population is at a particularly high risk for catheter-associated bloodstream infections (CABSI). Chlorhexidine for skin antisepsis is well documented to effectively decrease the incidence of bloodstream infections associated with central venous catheters in other populations. The project described in this article demonstrates that chlorhexidine for central venous catheter insertion and line maintenance in the neonatal population safely and effectively reduces CABSI.

Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach.

Problem: Bloodstream infections associated with catheters were the most common nosocomial infections in one paediatric intensive care unit in 1994-7, with rates well above the national average.

Design: Clinical data were collected prospectively to assess the rates of infection from 1994 onwards. The high rates in 1994-7 led to the stepwise introduction of interventions over a five year period.

Use of DNA fingerprinting in decision making for considering closure of neonatal intensive care units because of Pseudomonas aeruginosa bloodstream infections.

Background: Bloodstream infections with Pseudomonas aeruginosa have been well-described in neonatal intensive care units (NICU) and have resulted in the temporary closure of some nurseries to new admissions. Nosocomial transmission of these infections has been verified by fingerprint analysis of the isolates. We utilized molecular fingerprinting to identify the source of bloodstream infections in an NICU and used this information to apply infection control measures that allowed the nursery to stay open and continue to accept referrals.

Enteral feeding tubes are a reservoir for nosocomial antibiotic-resistant pathogens.

Background: Patients and their surroundings are known reservoirs for nosocomial pathogens. Enteral feeding tubes and formula are not thought of as reservoirs for nosocomial organisms.

Methods: A prospective observation study was conducted comparing methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) cultured from nosocomial infections and MRSA/VRE cultured from enteral feeding tubes used in the same neonatal intensive care unit during the same time period but in different babies.