The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: a quality improvement study

The prevention of hospital-acquired pressure injuries (HAPIs) in children undergoing long-duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long-duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi-modal, multi-disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long-duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long-duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence-based, multi-modal, multidisciplinary HAPI prevention strategy

Mindful organizing as a healthcare strategy to decrease catheter-associated infections in neonatal and pediatric intensive care units. A systematic review and grading recommendations (GRADE) system.

PURPOSE: To explore the clinical evidence available on mindful organizing (MO) that will improve teamwork for positioning and managing central venous catheters in patients admitted to neonatal intensive care and other pediatric intensive care units to decrease central-line-associated and catheter-related bloodstream infections (CLABSI and CRBSI). METHODS: We searched several databases (PubMed, Embase, CINAHL, CENTRAL, SCOPUS, and Web of Science) up to June 2018. We included studies investigating the effectiveness of MO teamwork in reducing CLABSI and CRBSI. The systematic review followed the PRISMA guidelines. We used validated appraisal checklists to assess quality. RESULTS: Seven studies were included: only one was a non-randomized case-controlled trial (CCT). All the others had a pre-post intervention design, one a time-series design and one an interrupted time-series design. The methodological heterogeneity precluded a meta-analysis. Despite the low certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, three studies including thousands of participants provided numerical data for calculating risk ratios (RR) and 95% confidence intervals (CI) comparing MO with no intervention for decreasing the CLABSI rate in neonatal and pediatric ICUs. The one CCT disclosed no significant difference in the CLABSI rate decrease between groups (RR = 0.96; 95%CI 0.47-1.97). Nor did the pre- and post-intervention interrupted time-series design disclose a significant decrease (RR = 0.80; 95%CI 0.36 1.77). In the study using a before-after study design, the GRADE system found that the CLABSI rate decrease differed significantly in favor of post-intervention (RR = 0.13; 95%CI 0.03 0.57; p = 0.007). CONCLUSIONS: Despite the decreased CLABSI rate, the available evidence is low in quality. To reduce the unduly high CLABSI rates in neonatal and pediatric intensive care settings, custom-designed clinical trials should further define the clinical efficacy of MO to include it in care bundles as a new international standard

Studio di coorte prospettico multicentrico per la validazione italiana della Braden Q per la valutazione del rischio di lesioni da decubito nei neonati e nei bambini fino ad 8 anni

I bambini ricoverati in particolari contesti quali le terapie intensive, le oncologie e le neurologie/neurochirurgiche sono a rischio di sviluppare lesione da pressione. Obiettivo. Validare la versione italiana della Braden Q per la valutazione del rischio di sviluppare lesioni da pressione nei bambini. Metodi. La popolazione è costituita da bambini da 21 giorni agli 8 anni, ricoverati nelle terapie intensive e subintensive. Sono esclusi i bambini prematuri, i ricoverati con lesioni da pressione e anamnesi positiva per cardiopatie congenite. Lo studio è di coorte prospettico, multicentrico con valutazioni del rischio ripetute. La prima rilevazione è stata effettuata dopo 24 ore dal ricovero, con la Braden Q nella versione di Suddaby. Le lesioni da pressione sono state valutate con la Skin Assessment Tool (SAT) e stadiate secondo la National Pressure Ulcer Advisory Panel. Risultati. Su 157 casi sono state eseguite 524 osservazioni. L’incidenza delle lesioni da pressione è del 17.2%. Solo l’analisi per specifiche sottocategorie rileva una buona accuratezza diagnostica: nei bambini dai 3 agli 8 anni l’accuratezza è del 71.4%; nei reparti di terapia sub-intensiva è dell’85.6%. Il valore massimo dell’accuratezza diagnostica (86.2%) è con i bambini dai 3 agli 8 anni ricoverati nei reparti sub intensivi. Conclusione. La scala Braden Q può essere usata affidabilmente ed ha buoni valori di accuratezza diagnostica con i bambini da 3 a 8 anni ricoverati nelle terapie sub-intensive, nei reparti di oncologia o di onco-ematologia pediatrica e di neurologia infantile

Hand Hygiene Compliance Rates in 9 Pediatric Intensive Care Units Across Europe: Results from the Reducing Antimicrobial use and Nosocomial Infections in Kids Network.

A unified surveillance mechanism for hand hygiene and hospital-acquired infections for pediatric wards is lacking in Europe. We managed to setup such a mechanism in 9 pediatric intensive care units in 7 European countries, using World Health Organization's definitions and common methodology which allows for benchmarking among units and countries. Median hand hygiene compliance was found high 82.3% (interquartile range 71.6-94.5%), but gaps in practices were identified