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

Linam, W. Matthew; Marrero, Elizabeth M.; Honeycutt, Michele D.; Wisdom, Christy M.; Gaspar, Anna; Vijayan, Vini

We used the Model for Improvement as the primary QI framework. 22 Interventions were tested using multiple plan, do, study, act cycles. We incorporated successful interventions into standard practice. Outcome and process measure data were displayed over time using run charts and statistical process control charts. Annotations helped show the relationship between interventions and changes in the data. Standard rules were used to detect shifts and trends in the data that were unlikely to have occurred by chance. [22] [23] [24] Measurement Outcome Measure. HARVIs were identified by trained Infection Preventionists during prospective surveillance using standard National Health and Safety Network definitions. 25 We defined a HARVI as a patient with a positive nasopharyngeal PCR for a respiratory virus and new symptoms (ex. fever, hypothermia, apnea, bradycardia, respiratory symptoms or increased respiratory support) representing a significant clinical change that developed during hospitalization but after the typical incubation period for the virus (2-5 days depending on the virus). Respiratory viruses were detected using a respiratory pathogen PCR panel (RPP; Biofire, Biomerieux Diagnostics, Salt Lake City, Utah) and included: adenovirus, coronavirus, human metapneumovirus, human rhinovirus/ enterovirus, influenza A, influenza B, parainfluenza, and respiratory syncytial virus (RSV). The panel did not distinguish rhinovirus and enterovirus. We report HARVIs as the rate of HARVIs/1,000 patient days.