Claudia Espinosa

The effect of transfers between health care facilities on costs and length of stay for pediatric burn patients

Hospitals vary widely in the services they offer to care for pediatric burn patients. When a hospital does not have the ability or capacity to handle a pediatric burn, the decision often is made to transfer the patient to another short-term hospital. Transfers may be based on available specialty coverage for children; which adult and non-teaching hospitals may not have available. The effect these transfers have on costs and length of stay (LOS) has on pediatric burn patients is not well established and is warranted given the prominent view that pediatric hospitals are inefficient or more costly. The authors examined inpatient admissions for pediatric burn patients in 2003, 2006, and 2009 using the Kids’ Inpatient Database, which is part of the Healthcare Cost and Utilization Project. ICD-9-CM codes 940 to 947 were used to define burn injury. The authors tested if transfer status was associated with LOS and total charges for pediatric burn patients, while adjusting for traditional risk factors (eg, age, TBSA, insurance status, type of hospital [pediatric vs adult; teaching vs nonteaching]) by using generalized linear mixed-effects modeling. A total of n = 28,777 children had a burn injury. Transfer status (P < .001) and TBSA (P < .001) was independently associated with LOS, while age, insurance status, and type of hospital were not associated with LOS. Similarly, transfer status (P < .001) and TBSA (P < .001) was independently associated with total charges, while age, insurance status, and type of hospital were not associated with total charges. In addition, the data suggest that the more severe pediatric burn patients are being transferred from adult and non-teaching hospitals to pediatric and teaching hospitals, which may explain the increased costs and LOS seen at pediatric hospitals. Larger more severe burns are being transferred to pediatric hospitals with the ability or capacity to handle these conditions in the pediatric population, which has a dramatic impact on costs and LOS. As a result, unadjusted, pediatric hospitals are seen as being inefficient in treating pediatric burns. However, since pediatric hospitals see more severe cases, after adjustment, type of hospital did not influence costs and LOS. TBSA and transfer status were the predictors studied that independently affect costs and LOS.

Update on the management of hepatitis B and C infections in the neonatal period

Hepatitis B virus and hepatitis C virus have received a significant amount of attention in recent years, and both viruses share a significant amount of similarities with one another beyond just that they both primarily target the liver. In recent years, cases of both infections have been fueled by a nationwide epidemic of injection drug use. Most relevant to this audience, they are both transmitted from mother to child. The increased cases in young adults combined with mother to child transmission translate into more exposed infants that will need to be managed and followed. Screening of pregnant women for hepatitis B infection coupled with appropriate treatment and prophylaxis measures are incredibly effective to preventing transmission. Prevention of hepatitis C infection is not yet possible, but advances in antiviral therapy make interruption of transmission a future possibility.

Effect of Intranasal Mupirocin Prophylaxis on Methicillin-Resistant Staphylococcus aureus Transmission and Invasive Staphylococcal Infections in a Neonatal Intensive Care Unit

The use of monthly intranasal mupirocin was associated with a significant reduction in the rate of methicillin-resistant Staphylococcus aureus transmission and Staphylococcus aureus invasive infection in a large neonatal intensive care unit. Resistance to mupirocin emerged over time, but it was rare and was not associated with adverse clinical outcomes.Infect Control Hosp Epidemiol 2018;39:741-745.

Unique Challenges of Hepatitis C in Infants, Children, and Adolescents

PURPOSE Hepatitis C, a chronic disease with deadly consequences, is no longer predominantly a disease of older people. METHODS A limited search was conducted of the relevant literature on 2 topics: (1) the impact of hepatitis C on infants exposed by vertical transmission; and (2) the impact of hepatitis C infection on infected children and adolescents. The findings were supplemented by the first-hand experience of the authors. FINDINGS Young people, including women of childbearing age, infants, children, and adolescents, are being especially affected by hepatitis C infection secondary to the intravenous drug use and opioid epidemic. Unfortunately, estimates of disease in young populations are all misleading because universal screening has not been implemented. IMPLICATIONS Lack of implementation of policies for screening and therapy on most affected populations will be responsible for perpetuation of this infection. In the era of highly effective therapy and a regimen that is approved by the US Food and Drug Administration for children, this outcome is unacceptable.

Is there Failure to Screen for Hepatitis C in Newborns Suffering from Neonatal Abstinence Syndrome

Abstract Background Enormous advances in treating/curing patients suffering from Hepatitis C (HepC) infection have occurred; resulting in many states mandating screening for HepC for older individuals. Unfortunately, no protection of screening exists for newborns. In Kentucky, rates of HepC among pregnant women are the second highest within the U.S., which has been associated to high intravenous drug use. Infants born to those women are at risk of HepC infection and other conditions such as neonatal abstinence syndrome (NAS). The current study examined the rate of HepC screening in a high-risk cohort (newborns suffering from NAS) and it’s impact on policy-making for this vulnerable population. Methods Kentucky Medicaid records, from 2015, were obtained to develop a detailed demographic, behavioral, clinical, and diagnostic data set (n = 152,749). NAS was defined by ICD-9 code 779.5 and ICD-10 code P96.1. HepC screening was defined by CPT codes (CPT 87520 [HCV, direct probe], 87521 [HCV, amplified probe], and 87522 [HCV RNA, Quantitative] or antibody [CPTs 86803–4]). Initially a descriptive study was performed, then multiple logistic regression techniques were used to test what variables impacted the odds of not being screened for HepC. Results A total of 1234 newborns with NAS were identified. The majority showed signs of NAS within 24 hours (64%), were white (68%) and were admitted to the hospital for an average of 24.8 days. Only one-in-three newborns with NAS (n = 412, 33.4%) were screened for HepC. Non-Whites (OR = 1.58, 95% CI 1.45–1.71, P < 0.001) and those living in non-urban areas (OR = 1.42, 95% CI 1.28–1.56, P < 0.001) were the only study variables to significantly impact the odds of not being screened for HepC (for newborns suffering from NAS). Conclusion A high-risk and vulnerable population for HepC may not be getting screened for HepC and thus are being underserved by the health care system. Non-Whites and those in rural areas are the most affected. Solutions and policies need to be focused on this population and area where screening is lacking. Optimization of maternal screening for HepC is crucial in high-risk populations. Disclosures All authors: No reported disclosures.

Missed Opportunities for Human Papillomavirus Vaccine Initiation in an Insured Adolescent Female Population

In this cohort of nearly 15000 11-year-old girls with insurance (commercial or Medicaid), the human papillomavirus vaccine was administered at only 1 in 4 well-adolescent visits and approximately one-third of vaccine-related visits, which suggests a substantial number of missed opportunities.

978Infectious Complications of Extended Peripheral Intravenous Catheters (EPIVs) in a NICU

Background. Central line-associated bloodstream infections (CLABSIs) are important causes of morbidity and mortality in neonatal intensive care unit (NICU) patients. Extended peripheral intravenous catheters (EPIVs) are increasingly used as an alternative to central venous catheterization in some NICUs, but data about infectious complications are lacking. The frequency of infectious complications of EPIVs in 101bed Level IV NICU utilizing these catheters since November 2011 is described. Methods. All BSIs were prospectively identified in neonates cared for in a NICU between January and December 2013. CLABSIs were designated according to NHSN definitions. Infections that would have met the NHSN CLABSI definition but had an EPIV in place rather than a CL were classified as EPIV-associated blood stream infections (EPIV-aBSIs). Results. Between January, 1 and December 31, 2013, there were 227 EPIV insertions. Bacteremia developed in 3 infants with EPIVs (E. coli = 2, methicillin-resistant S. aureus (MRSA) =1). The EPIV-aBSI rate was 1.8/1,000 catheter days, compared to the CLABSI rate of 1.04/1,000 device days (total infections = 7). Two infants developed local infectious complications (abscess or necrosis at line site). Conclusion. EPIVs were associated with appreciable infectious morbidity in this NICU. The EPIV-aBSI rate was higher than the CLABSI rate. Standardized, evidencebased protocols for the insertion and maintenance of EPIVs are needed. Reporting only CLABSI rates in the NICU underestimates the burden of bacteremia associated with intravenous catheterization. Disclosures. All authors: No reported disclosures.

Ability to Deliver Services in Spanish: A Survey of Michigan Home Health Agencies, 2012

The capacity of home health agencies to serve children from families with low English proficiency is not well understood. We conducted an exploratory survey of home health agencies in Michigan in 2012 to document whether they can provide services in Spanish, serve children, and accept Medicaid.