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
Hessels, Amanda J; Murray, Meghan T; Cohen, Bevin et al. (2018) Perception of Patient Safety Culture in Pediatric Long-Term Care Settings. J Healthc Qual 40:384-391
Burgermaster, Marissa; Murray, Meghan; Saiman, Lisa et al. (2018) Associations Between Enteral Nutrition and Acute Respiratory Infection Among Patients in New York Metropolitan Region Pediatric Long-Term Care Facilities. Nutr Clin Pract 33:865-871
Wilmont, Sibyl; Hessels, Amanda J; Kelly, Ana M et al. (2018) Family Experiences and Perspectives on Infection Prevention in Pediatric Long-Term Care. Rehabil Nurs 43:307-314
Murray, M T; Johnson, C L; Cohen, B et al. (2018) Use of antibiotics in paediatric long-term care facilities. J Hosp Infect 99:139-144
Larson, Elaine L; Murray, Meghan T; Cohen, Bevin et al. (2018) Behavioral Interventions to Reduce Infections in Pediatric Long-term Care Facilities: The Keep It Clean for Kids Trial. Behav Med 44:141-150
Hessels, Amanda J; Murray, Meghan; Cohen, Bevin et al. (2017) Patient Safety Culture Survey in Pediatric Complex Care Settings: A Factor Analysis. J Patient Saf :
Hessels, Amanda J; Agarwal, Mansi; Saiman, Lisa et al. (2017) Measuring patient safety culture in pediatric long-term care. J Pediatr Rehabil Med 10:81-87
Hessels, Amanda J; Darby, Sharon W; Simpser, Edwin et al. (2017) National Testing of the Nursing-Kids Intensity of Care Survey for Pediatric Long-term Care. J Pediatr Nurs 37:86-90
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; 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

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