QAPI 19 - Bridging the Gap: Utilizing Quality Improvement Tools to Refine a Pediatric Varicella Exposure Investigation

Monday, June 26, 2023

3:00 PM – 3:20 PM

Location: W103 A/B; Orange County Convention Center

CE: 0.33

CNE Credits: 0.33
CME Credits: 0.33

Presenter(s)

Riley Moore, MPH

Infection Preventionist
Infection Prevention and Control, Ann & Robert H Lurie Children's Hospital of Chicago
Chicago, Illinois

Disclosure(s): No financial relationships to disclose

PDF

Co-Author(s)

Amanda Bonebrake, MPH, CIC

Infection Preventionist
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois
ND

Nicole Davies, MBA, BSN, RN

Infection Preventionist
Infection Prevention and Control, Ann & Robert H. Lurie Children's Hospital of Chicago
MM

Maeve Marsh, MPH

Infection Preventionist
Infection Prevention and Control, Ann & Robert H. Lurie Children’s Hospital of Chicago
MM

Matthew P. McHugh, MT(ASCP), MPH, CIC

Infection Preventionist
Infection Prevention and Control, Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois
AP

Ami Patel, MD, MPH

Associate Medical Director
Division of Infectious Diseases and Department of Infection Prevention and Control, Ann & Robert H. Lurie Children’s Hospital of Chicago
LK

Larry Kociolek, MD, MSCI, FSHEA, FPIDS

Medical Director
Division of Infectious Diseases and Department of Infection Prevention and Control, Ann & Robert H. Lurie Children’s Hospital of Chicago
Anna O'Donnell, MSN, RN, CIC, FAPIC

Director Infection Prevention and Control
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois

Moderator(s)

Lauren Le Goff, MS, MLS(ASCP), CIC, FAPIC (she/her/hers)

Manager, Infection Prevention
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania

Disclosure(s): No financial relationships to disclose

Co-Moderator(s)

Mohamed N. Elhadidi, Msc, MBA,FISQua,CIC,LTC-CIP (he/him/his)

Chief of infection control
Dallah healthcare
Riyadh

Disclosure(s): No financial relationships to disclose

Background: As vaccination rates among pediatric patients decrease, there is increased risk of re-emergence and spread of vaccine preventable diseases. When patients present for care, crowded emergency department (ED) waiting rooms can further exacerbate the risk of transmission. For primary varicella-zoster virus (VZV) infection, early identification of infectious patients and exposed individuals is critical in the post-exposure management of susceptible patients.

Methods: The Infection Prevention & Control (IP&C) team at a 368-bed acute care pediatric hospital was notified via laboratory reporting of a case of varicella in an unmasked infant evaluated in the ED. Following confirmation, an investigation was conducted by the IP&C team to identify exposed patients for notification and potential interventions, such as vaccination and/or Varicella Zoster Immune Globulin (VZIG) treatment. A gap analysis, which is an exercise to compare current with desired performance, was completed to refine the process for future investigations.

Results: Because of delays in initiating airborne precautions related to unusually high ED volumes, 141 patients were identified as sharing airspace for at least one hour with the index patient; physical proximity of patients in the ED was unable to be determined retrospectively. Of those, 42 (29.8%) were identified as at-risk for VZV infection due to immune status; 4 were eligible for VZIG administration. A gap analysis conducted by the IP&C team identified three opportunities for process improvement: prompt screening and isolation of infectious patients in the ED; informatic support to identify exposed individuals; and written/verbal communication of event with third parties.

Conclusions: For communicable diseases such as VZV where post-exposure interventions must be initiated promptly, early identification of infectious patients and exposed individuals is necessary. When processes fail, quality improvement tools like a gap analysis can provide IP&C teams with a framework to review current practices and determine actions to take to improve processes.

Learning Objectives:

Describe the epidemiology of Varicella infections in pediatric patients including the incubation period for exposed individuals.
Define the three components of a gap analysis
Apply a gap analysis framework to infection prevention practices for process improvement.