QAPI 21 - Effects of Decolonization Protocols in Pediatric Critical Care Populations

Background: Methicillin-resistant Staphylococcus aureus (MRSA) infections are known to cause increased morbidity and mortality in pediatric critical care (CC) populations. The use of decolonization protocols in adult CC populations is widely utilized. However, in pediatric populations decolonization protocols are sparce. Our objective was to implement a decolonization protocol and analyze the effects on patient outcomes.

Methods: This quality improvement project was initiated in the cardiac intensive care unit (CICU), neonatal intensive care unit (NICU), and pediatric intensive care unit (PICU) in an academic pediatric medical center. Decolonization protocols were developed and implemented in the identified CC areas. MRSA Bacteremia and MRSA rates were analyzed pre- and post-intervention. Hospital-onset MRSA bacteremia and MRSA cases were identified using criteria from the National Healthcare Safety Network (NSHN).

Results: Decolonization protocols were developed to include the under and over 2 years of age patients admitted to the CICU, NICU, and PICU. The pre-intervention phase took place between January and October 2021 and the post-intervention took place between November 2021 and August 2022. In the pre-intervention period, there were a total of 2,316 admissions and 15,765 patient days with an average length of stay of 6.8 days. In the post-intervention period, there were a total of 2,778 admissions and 17,296 patient days with an average length of stay of 6.2 days. The hospital-onset MRSA rate/1000 patient days decreased from 1.459 to 0.867. The hospital-onset MRSA bacteremia rate/1000 patient days decreased from 0.381 to 0.173.

Conclusions: Decolonization protocols showed a reduction in hospital-onset MRSA and hospital-onset MRSA bacteremia rates by 41% and 54% respectively in pediatric CC populations. Utilizing decolonization protocols in pediatric CC populations improves patient outcomes.