Reducing infections in young patients
March 20, 2018
By Thom Wellington
My column is normally focused on innovation and techniques used in effectively reducing health care associated infections (HAIs) in hospital patient populations.
However, this month I would like to focus on innovation in pediatric care that may be natural for young physicians, but a paradigm shift for older pediatric docs. Innovation is quickly weaving its way into health care with younger patients and families welcoming the changes. Beyond the technological advances, infection prevention in pediatrics remains to be an important factor as innovation transforms the delivery of health care.
Most everyone is witnessing the increased focus on infection prevention. Billboards along highways stress the importance of handwashing. Disinfecting wipes are provided to wipe the handles on grocery carts and restaurants leave individually packaged hand wipes in place of breath mints in decorative bowls near hostess stands. Inside our hospitals the efforts to reduce infections go far deeper with teams of infection preventionists (IPs) checking patient data, making sure clean linen carts are properly draped, checking negative pressure rooms and even overseeing sink placement during construction planning.
The reason for change in focus over the last decade is twofold: health care associated infections are responsible for 205 deaths per day; and hospitals are no longer reimbursed by insurance providers or from the Centers for Medicare and Medicaid Services (CMS) for continued care to patients experiencing an HAI. As most HAIs are preventable, companies have jumped at the opportunity to develop ways to reduce HAIs using innovation for delivery of health care to patients.
When evaluating new innovations, it is important to consider the differences between children and adults when it comes to preventing health care associated infections.
Factors that must be taken into consideration in pediatric care include a child’s underdeveloped immune system compared with the immune system of adult patients, and that some children are too young to receive vaccines. Vectors for transmission of infections between children are often different than adults and include shared toys and books, play areas, etc. Children are also accompanied by parents, siblings and additional visitors, who introduce more opportunities for transmission of HAIs. Pediatric infection prevention plans must include these additional people and the potential for transmitting infections in the hospital to young patients.
Technology is also taking a role in reducing infections for pediatric patients. Moving the children out of pediatric waiting rooms is slowly occurring with the use of telehealth and virtual visits, when possible. The added development of connected devices like the CellScope to do a virtual ear exam and the Spirotel, a pocket-sized spirometer for respiratory analysis, can reduce the need for some doctor’s office visits, thus eliminating potential exposure to harmful bacteria and active viruses.
It won’t be long before medical advice from big data will be available even on home devices such as Google Home and Amazon’s Alexa. These intelligent/virtual personal assistants will soon combine with WebMD and other medical data databases to provide guidance on identifying symptoms and preliminary medical advice. Advanced next-generation software tied to medical data is more commonly used by young pediatricians looking for faster symptom analysis which can be beneficial to a large percentage of patients.
Beyond a doctor’s acceptance of technology, some health systems are turning to big data such as IBM’s Jeopardy-winning supercomputer Watson. As health systems begin a data dump of patient information into computers with artificial intelligence (AI) capability, new treatment options are appearing. Watson, filled with cancer treatment plans provided by doctors at the University of North Carolina School of Medicine, along with Watson’s abundant medical research data uncovered additional options beneficial to patients. No Ivy League med school graduate can match the enormous amount of medical research combined with AI in treating any patient.
Beyond new technologies, pediatric care in hospitals still means concern about the same organisms present in adult care facilities, including drug-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA). Consequently, antimicrobial stewardship plays an equally important role in preventing the emergence of resistance in bacterial infections in children's hospitals. The American Academy of Pediatrics (AAP) continues to recommend mandatory immunizations for all staff. Some pediatric facilities also require all contractors and vendors to be immunized.
As medical delivery continues to evolve with the emergence of new technologies, pediatric care still requires holding on to basic concepts of medicine now overlaid on different platforms. Working to keep pediatric patients safe while in medical offices and in hospital care requires understanding the child’s developing immune system and routes of exposure. Hospitals and clinics that specialize in pediatric care have benefited from new technology, big data research and clinical studies that have provided lessons in safer practices that can increase quality outcomes for children.
About the author: Thom Wellington is the CEO and a stockholder in Infection Control University.