Linam W Matthew, Marrero Elizabeth M, Honeycutt Michele D, Wisdom Christy M, Gaspar Anna, Vijayan Vini
Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Ga.
Infection Prevention and Control Department, Arkansas Children's Hospital, Little Rock, Ark.
Pediatr Qual Saf. 2019 Dec 16;4(6):e242. doi: 10.1097/pq9.0000000000000242. eCollection 2019 Nov-Dec.
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%.
This quality improvement project took place in a large tertiary NICU to reduce HARVIs. Interventions primarily focused on improving FVHH and reducing visitation by symptomatic family members and visitors. We defined correct FVHH as hand hygiene performed immediately before touching their child. Hand hygiene observations were performed by direct observation by NICU staff using a standardized tool. Interventions to improve FVHH included education of staff and visitors, reminder signs, and immediate reminders to families to prevent lapses in hand hygiene. Staff screened family and visitors before NICU entry. Symptomatic individuals were asked to defer visitation until symptoms resolved. HARVIs were identified during prospective surveillance by infection preventionists using standard definitions.
Baseline FVHH was 27% in 2015. After May 2017, the average FVHH remained at 85%. When reminded, family members and visitors performed hand hygiene 99% of the time. Staff screened ~129,000 people for FVHH. Between January 2013 and March 2019, there were 74 HARVIs; 80% were rhinovirus/enterovirus. After the implementation of improved FVHH, the HARVI rate decreased from 0.67 to 0.23/1,000 patient days.
Adding interventions to improve FVHH and visitor management to existing healthcare worker prevention efforts can help reduce HARVIs in the NICU.
医疗保健相关的呼吸道病毒感染（HARVIs）对新生儿重症监护病房（NICU）中的婴儿造成了重大伤害。医护人员和访客可能成为向患者传播病毒的载体。我们假设改善家属和访客的手部卫生（FVHH）以及对访客进行筛查能够使HARVIs减少至少25%。
本质量改进项目在一家大型三级NICU开展，旨在减少HARVIs。干预措施主要集中在改善FVHH以及减少有症状的家属和访客的探视。我们将正确的FVHH定义为在接触孩子之前立即进行手部卫生清洁。手部卫生观察由NICU工作人员使用标准化工具进行直接观察。改善FVHH的干预措施包括对工作人员和访客进行教育、设置提醒标识以及立即提醒家属防止手部卫生出现疏漏。工作人员在NICU入口处对家属和访客进行筛查。有症状的人员被要求推迟探视，直到症状消失。感染预防人员在前瞻性监测期间使用标准定义识别HARVIs。
2015年基线FVHH为27%。2017年5月之后，平均FVHH保持在85%。当得到提醒时，家属和访客99%的时间会进行手部卫生清洁。工作人员对约129,000人进行了FVHH筛查。在2013年1月至2019年3月期间，共发生74例HARVIs；80%为鼻病毒/肠道病毒。实施改善FVHH措施后，HARVI发生率从0.67降至0.23/1000患者日。
在现有的医护人员预防措施基础上增加改善FVHH和访客管理的干预措施，有助于减少NICU中的HARVIs。
