Infection Risks in Pediatric Long-Term Care Facilities
High Risk of Pathogen Transmission
Pediatric patients in long-term care facilities face significant risks of pathogen transmission. Factors such as multibed bedrooms, shared dining areas, and the presence of an on-site school contribute to this heightened vulnerability. It is essential to identify risk factors associated with common infections, especially respiratory tract infections, to develop evidence-based strategies aimed at reducing and controlling pathogen transmission.
Patient Demographics and Resource Needs
Pediatric patients discharged from acute care hospitals are often referred to pediatric long-term care facilities (pLTCFs) for extended care. The complexity and volume of patients in these facilities are increasing rapidly, necessitating substantial healthcare resources and funding for effective operations. Infection control remains a major concern in long-term care settings, particularly for pediatric and geriatric populations. Understanding the incidence, types, and rates of infections is crucial in formulating strategies to mitigate infection risks in these groups.
Recent Study Overview
A recent prospective study published in JAMA Pediatrics examined infections among pediatric patients requiring long-term care. This research is part of a broader initiative known as Keep It Clean for Kids (KICK), which aims to reduce infections in pLTCFs. Researchers recruited 717 residents aged 21 years or younger from three sites across the United States and monitored them over three years, focusing on the incidence, rate, and types of infections, as well as identifying risk factors for infection in this population to develop preventative strategies.
Findings on Comorbid Conditions and Infections
The study revealed that the most prevalent chronic comorbidities included musculoskeletal or ambulation issues, neurologic disorders, respiratory conditions, and gastrointestinal problems. Interestingly, the types of chronic comorbidities varied among the three sites studied. Over the three-year period, 2,052 infections were diagnosed, with respiratory tract infections (RTIs), otitis/conjunctivitis, and skin and soft-tissue infections being the most common. This contrasts with earlier findings that urinary tract infections (UTIs) and pneumonia are the most prevalent infections in hospitalized adults and children, respectively. The study also documented 62 infection outbreaks, impacting 819 residents, primarily caused by respiratory viruses such as rhinovirus and enterovirus.
Identifying Risk Factors for Infections
The authors identified several significant risk factors for respiratory tract infections, including younger age, a higher number of chronic comorbid conditions, and the presence of medical devices such as feeding tubes or tracheostomies. The characteristics of pLTCFs, including shared living spaces and communal activities, contribute to the risk of pathogen transmission.
Implications for Future Research
The findings of this study underscore the importance of developing evidence-based strategies to prevent and reduce infections in pediatric long-term care facilities. While respiratory infections were identified as the predominant risk, the study highlighted the need for additional research to uncover other potential risk factors, such as site-specific infrastructure, architecture, and infection prevention strategies that may influence infection rates. Future efforts should focus on identifying these unknown variables to enhance strategies for minimizing pathogen transmission and infection risks.
Written by Haisam Shah, BSc, Saiman, L., Maykowski, P., Murray, M., Cohen, B., Neu, N., Jia, H., … & Larson, E. (2017). Incidence, risks, and types of infections in pediatric long-term care facilities. JAMA Pediatrics.