Keep It Clean for Kids: The KICK Project Healthcare-associated infections (HAIs) are the leading cause of morbidity and mortality in long term care facilities (LTCF) and are responsible for nearly 400,000 deaths each year in this population. Children in pediatric LTCF represent a highly vulnerable patient population with numerous co morbid conditions at high risk of contracting HAIs caused by multidrug-resistant organisms as well as by viral pathogens. Although such infections have been the focus of mainstream media attention, little empirical research has been conducted to prevent HAIs in LTCF, particularly in pediatric LTCF. The goal of this study is to reduce HAIs in pediatric LTCF by improving the patient safety climate and infection prevention practices.
Specific aims of this study are to: 1. Describe the rates and types of healthcare-associated bacterial and viral infections in pediatric long term care facilities; 2. Assess the impact of a theoretically-based group-level behavioral intervention on rates of HAIs in pediatric long term care facilities (primary outcome); 3. Measure the impact of a theoretically-based group-level behavioral intervention on the number of outbreaks, antimicrobial utilization in patients, hospitalizations of patients, staff absenteeis (secondary clinical outcomes);and 4. Examine the impact of a theoretically-based group-level behavioral intervention on hand hygiene frequency using an innovative automated monitoring and feedback system to provide real-time feedback, and patient safety climate (secondary process outcomes). Three pediatric long term care facilities (284 beds) in the greater NYC metropolitan area will be included in a multi-disciplinary intervention, Keep It Clean for Kids (KICK) Project, modeled after the WHO interventions, the actionable feedback model, and a successful program from acute care. The KICK Project includes five key components: explicit leadership commitment, active participation of the staff, conducting work flow assessments, staff training in the WHO '5 Moments for Hand Hygiene'and electronic monitoring and feedback of hand hygiene. KICK teams comprised of clinical and administrative leaders will plan and implement changes. An interrupted time series analyses of the primary outcome (rates of HAIs) and secondary outcomes will be conducted.

Public Health Relevance

Children in pediatric long term care account for 40% of all medical expenditures for children overall and represent a vulnerable patient population at high risk of contracting healthcare-associated infections caused by multidrug-resistant organisms and viral pathogens. Despite this, there has been minimal attention to the prevention of infections in this group. This study will be the first to provide vital information about rates and types of infections in these children and to test an intervention that will be generalizable to multiple chronic care facilities to reduce epidemic and endemic infections.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
1R01HS021470-01
Application #
8340911
Study Section
Special Emphasis Panel (HSQR)
Program Officer
Cleeman, James
Project Start
2012-07-01
Project End
2016-06-30
Budget Start
2012-07-01
Budget End
2013-06-30
Support Year
1
Fiscal Year
2012
Total Cost
Indirect Cost
Name
Columbia University (N.Y.)
Department
Type
Schools of Nursing
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032
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Murray, Meghan T; Jackson, Olivia; Cohen, Bevin et al. (2016) Impact of Infection Prevention and Control Initiatives on Acute Respiratory Infections in a Pediatric Long-Term Care Facility. Infect Control Hosp Epidemiol 37:859-62
Navarra, Ann-Margaret; Schlau, Rona; Murray, Meghan et al. (2016) Assessing Nursing Care Needs of Children With Complex Medical Conditions: The Nursing-Kids Intensity of Care Survey (N-KICS). J Pediatr Nurs 31:299-310
Løyland, Borghild; Wilmont, Sibyl; Hessels, Amanda J et al. (2016) Staff Knowledge, Awareness, Perceptions, and Beliefs About Infection Prevention in Pediatric Long-term Care Facilities. Nurs Res 65:132-41
Cohen, Bevin; Murray, Meghan; Jia, Haomiao et al. (2016) Is hand hygiene frequency associated with the onset of outbreaks in pediatric long-term care? Am J Infect Control 44:1492-1494
Løyland, Borghild; Wilmont, Sibyl; Cohen, Bevin et al. (2016) Hand-hygiene practices and observed barriers in pediatric long-term care facilities in the New York metropolitan area. Int J Qual Health Care 28:74-80
Murray, Meghan T; Pavia, Marianne; Jackson, Olivia et al. (2015) Health care-associated infection outbreaks in pediatric long-term care facilities. Am J Infect Control 43:756-8
Carter, Eileen J; Cohen, Bevin; Murray, Meghan T et al. (2015) Using Workflow Diagrams to Address Hand Hygiene in Pediatric Long-Term Care Facilities. J Pediatr Nurs 30:e17-21
Murray, Meghan T; Neu, Natalie; Cohen, Bevin et al. (2015) Developing Case Definitions for Health Care-Associated Infections for Pediatric Long-Term Care Facilities. Clin Pediatr (Phila) 54:1380-2
Larson, Elaine L; Cohen, Bevin; Murray, Meghan et al. (2014) Challenges in conducting research in pediatric long-term care facilities. Clin Pediatr (Phila) 53:1041-6

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