Initiation of interdisciplinary prevention rounds: decreasing CLABSIs in critically ill children.

Objective: Central line-associated bloodstream infections (CLABSIs) harm children. Insertion and maintenance bundles have significantly reduced CLABSIs, but infections still occur. The objective was to develop bedside infection prevention (IP) rounds and evaluate their impact on CLABSI rates.

Complement Inhibition in Severe COVID-19 Acute Respiratory Distress Syndrome.

Most children with COVID-19 have asymptomatic or mild illness. Those who become critically ill suffer from acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI). The rapid deterioration of lung function has been linked to microangiopathic and immune-mediated processes seen in the lungs of adult patients with COVID-19.

Pediatric research priorities in healthcare-associated infections and antimicrobial stewardship.

Objective: To develop a pediatric research agenda focused on pediatric healthcare-associated infections and antimicrobial stewardship topics that will yield the highest impact on child health.

Participants: The study included 26 geographically diverse adult and pediatric infectious diseases clinicians with expertise in healthcare-associated infection prevention and/or antimicrobial stewardship (topic identification and ranking of priorities), as well as members of the Division of Healthcare Quality and Promotion at the Centers for Disease Control and Prevention (topic identification).

Methods: Using a modified Delphi approach, expert recommendations were generated through an iterative process for identifying pediatric research priorities in healthcare associated infection prevention and antimicrobial stewardship.

Comparison of Upper Respiratory Viral Load Distributions in Asymptomatic and Symptomatic Children Diagnosed with SARS-CoV-2 Infection in Pediatric Hospital Testing Programs.

The distribution of upper respiratory viral loads (VL) in asymptomatic children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. We assessed PCR cycle threshold (Ct) values and estimated VL in infected asymptomatic children diagnosed in nine pediatric hospital testing programs. Records for asymptomatic and symptomatic patients with positive clinical SARS-CoV-2 tests were reviewed.

Quantitative SARS-CoV-2 Serology in Children With Multisystem Inflammatory Syndrome (MIS-C).

Objectives: We aimed to measure severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological responses in children hospitalized with multisystem inflammatory syndrome in children (MIS-C) compared with those with coronavirus disease 2019 (COVID-19), those with Kawasaki disease (KD), and hospitalized pediatric controls.

Methods: From March 17, 2020, to May 26, 2020, we prospectively identified hospitalized children with MIS-C ( = 10), symptomatic COVID-19 ( = 10), and KD ( = 5) and hospitalized controls ( = 4) at Children's Healthcare of Atlanta. With institutional review board approval, we obtained prospective and residual blood samples from these children and measured SARS-CoV-2 spike receptor-binding domain (RBD) immunoglobulin M and immunoglobulin G (IgG), full-length spike IgG, and nucleocapsid protein antibodies using quantitative enzyme-linked immunosorbent assays and SARS-CoV-2 neutralizing antibodies using live-virus focus-reduction neutralization assays.

Focusing on Families and Visitors Reduces Healthcare Associated Respiratory Viral Infections in a Neonatal Intensive Care Unit.

Unlabelled: Healthcare-associated respiratory viral infections (HARVIs) result in significant harm to infants in the neonatal intensive care unit (NICU). Healthcare workers and visitors can serve as transmission vectors to patients. We hypothesized that improved family and visitor hand hygiene (FVHH) and visitor screening would reduce HARVIs by at least 25%.

Congenital Toxoplasmosis Presenting as Eosinophilic Encephalomyelitis With Spinal Cord Hemorrhage.

A 4-week-old male neonate with a history of intermittent hypothermia in the newborn nursery presented with an acute onset of bilateral lower extremity paralysis and areflexia. Extensive workup demonstrated eosinophilic encephalomyelitis and multifocal hemorrhages of the brain and spinal cord. Funduscopic examination revealed bilateral chorioretinitis with macular scarring.

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.

Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis.

Naegleria fowleri is a thermophilic, free-living ameba that causes primary amebic meningoencephalitis. The infections are nearly always fatal. We present the third well-documented survivor of this infection in North America.

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.

Challenges and solutions: pandemic 2009 H1N1 influenza A in a pediatric emergency department.

Objective: The purpose of this study was to describe the impact of the 2009 H1N1 influenza pandemic on a pediatric emergency department (ED) at a freestanding children's hospital in the summer and fall of 2009.

Design: In July 2009, active prospective surveillance for influenza-like illness (ILI) was performed on a daily basis of patients presenting to the ED of Arkansas Children's Hospital. The Centers for Disease Control and Prevention definition of ILI was used.

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.

The influence of context on quality improvement success in health care: a systematic review of the literature.

Context: The mixed results of success among QI initiatives may be due to differences in the context of these initiatives.

Methods: The business and health care literature was systematically reviewed to identify contextual factors that might influence QI success; to categorize, summarize, and synthesize these factors; and to understand the current stage of development of this research field.

Findings: Forty-seven articles were included in the final review.

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.

Peripheral neuropathy in an adolescent treated with linezolid.

The increased incidence of methicillin-resistant Staphyloccocus aureus infections may increase linezolid use in children. Peripheral neuropathy is a rare adverse effect of linezolid therapy and is more frequent with prolonged courses. We present an adolescent with peripheral neuropathy after 4 months of linezolid therapy and review the literature related to linezolid-induced neuropathies.