Kyle M. Johnson

Improving waste segregation while reducing costs in a tertiary-care hospital in a lower–middle-income country in Central America

Healthcare waste (HCW) management and segregation are essential to ensure safety, environmental protection and cost control. Poor HCW management increase risks and costs for healthcare institutions. On-going surveillance and training are important to maintain good HCW practices. Our objectives were to evaluate and improve HCW practices at Hospital Bloom, San Salvador, El Salvador. We studied HCW disposal practices by observing waste containers, re-segregating waste placed in biohazardous waste bags, and administering a seven-itemsknowledge survey before and after training in waste management at Hospital Bloom. The training was based on national and international standards. We followed total biohazardous waste production before and after the training. The hospital staff was knowledgeable about waste segregation practices, but had poor compliance with national policies. Re-segregating waste in biohazardous waste bags showed that 61% of this waste was common waste, suggesting that the staff was possibly unaware of the cost of mis-segregating healthcare waste. After staff training in HCW management, the correct responses increased by 44% and biohazardous waste disposal at the hospital reduced by 48%. Better segregation of biohazardous waste and important savings can be obtained by HCW management education of hospital staff. Hospitals can benefit from maximising the use of available resources by sustaining best practices of HCW, especially those in hospitals in lower–middle-income countries.

The epidemiology and clinical characteristics of respiratory syncytial virus infection in children at a public pediatric referral hospital in Mexico.

OBJECTIVES The aim of this study was to determine the epidemiological and clinical characteristics of children with respiratory syncytial virus (RSV) treated at a public referral childrens hospital in Mexico. METHODS We reviewed RSV infection in patients aged 0-18 years who were treated at Hospital Infantil from January 2004 to December 2008. RESULTS During the 5 years, 2797 samples were tested for respiratory viruses; 356 samples were positive for any virus, including 266 (74.7%) positive for RSV. Complete clinical information was available for 205 RSV patients. The mean age was 22 months, and 33.7% of the infections were nosocomially acquired. Hospitalization occurred in 187 children. Of 14 deaths, nine were directly attributed to RSV infection. During the study, RSV infections were seen throughout the year, predominating in the colder months. Of the 205 patients, 79.0% (162/205) had an underlying disease. Congenital heart disease was found in 30.2% (49/162), including three children (33.3%) who died of RSV. Thirty-three patients (16.1%) with RSV required mechanical ventilation. None of the children with RSV received palivizumab or ribavirin. CONCLUSIONS RSV caused high hospitalization rates and admission to intensive care units, especially among those with underlying illnesses and young infants. The data presented here will be useful for strategies to improve outcomes in children at risk of complications.

Challenges in managing infections among pediatric cancer patients: Suboptimal national essential medicines lists for low and middle income countries

Infection management for pediatric cancer patients may be compromised in low and middle income countries (LMICs) if key antimicrobials are not included in national essential medicines lists. We screened national essential medicines lists for 81 LMICs, and assessed the frequency and corresponding 95% confidence limits (CL) of countries that included the 15 International Society of Paediatric Oncology‐recommended antimicrobial agents. Only 19% (95% CL: 11%, 28%) of countries included all recommended antimicrobials in their national essential medicines lists. The selection of antimicrobial agents for national essential medicines lists in LMICs warrants attention from a pediatric cancer perspective. Pediatr Blood Cancer 2015;62:204–207.

Predictors of wait-time for antibiotic initiation and association of wait-time with hospital length of stay and ICU admission among children with cancer at the Southern Philippines Medical Center.

Expedited antibiotic administration improves the survival of children with cancer and infection. A 1‐hour antibiotic wait‐time (AWT) post‐hospital arrival is a quality‐of‐care benchmark in healthcare. However, multiple factors preclude achieving this goal in developing countries. Predictors of AWT and its association with hospital length of stay (LOS) and intensive care unit (ICU) admission at the Southern Philippines Medical Center (SPMC) were identified.

Bloodstream infections and inpatient length of stay among pediatric cancer patients with febrile neutropenia in Mexico City

We assessed the association between bloodstream infections (BSIs) and inpatient length of stay among pediatric cancer patients with febrile neutropenia in Mexico City. The estimated length of stay for BSIs was 19 days, which corresponded with a 100% (95% confidence limits, 60%-160%) relative increase in the length of stay compared with patients for whom no pathogen was identified. Feasible options for reducing the length of stay should be considered to alleviate patient and resource burden.

Infection Prevention and Control Program in a Public Pediatric Hospital in Argentina: Opportunities for Improvement

interactions (both compliant and non-compliant) and was converted into a compliance rate. If a hospital-acquired infection (HAI) was identified, the interactions leading up to the event was reviewed to ascertain whether hand hygiene adherence played a possible role in transmission. The aggregated information was posted electronically on a monitor for real-time feedback to staff and included data on current usage and compliance rates and was also accessible by individual employees on the computer. Any of the data was able to be accessed with the click of a mouse for any defined time period. Data was able to be stratified by individual, unit, department, and discipline. EHHS was also able to send email reports regarding usage and rates to selective HCWs. Results: During the study period, hand hygiene compliance was as follows: 97% in 2011 (97,442 patient interactions); 94% in 2010 (9,788 interactions); 99% in 2009 (160 interactions); 98% in 2008 (102 interactions). Lesson Learned: Traditional data collection and extrapolation methods are time consuming and labor intensive to use. They tend to be biased by user subjectivity and offer a finite view of select patient interactions. EHHS reporting saves time and labor costs, objectively measures hand hygiene compliance continuously, presents information clearly and concisely, can be easily disseminated for real time feedback, and is available 24/7. Non-compliance can be addressed almost immediately. This newer technology allows for enhanced surveillance and improvement in both clinical outcomes and patient safety.

Epidemiology of Infections in a Pediatric Oncology Service in Guatemala

Lesson Learned: Our findings demonstrated statistically significant overall lower infection rates when reusable bathing cloths and basins were replaced with disposable CHG impregnated bath cloths. Statistically significant lower VAP rates were identified with the addition of CHG to the oral care protocol. Intervention strategies contributed to lower infection rates in all major sites monitored. Use of a standardized process measuring tool is necessary to monitor and sustain compliance with the intervention strategies. Ongoing efforts to implement new infection prevention strategies may improve patient outcomes in the critical care setting.