Focusing on Families and Visitors Reduces Healthcare Associated Respiratory Viral Infections in a Neonatal Intensive Care Unit

Abstract

Healthcare-associated respiratory viral infections (HARVIs) result in significant harm to infants in the neonatal intensive care unit (NICU). Healthcare workers and visitors can serve as transmission vectors to patients. We hypothesized that improved family and visitor hand hygiene (FVHH) and visitor screening would reduce HARVIs by at least 25%.

Methods: This quality improvement project took place in a large tertiary NICU to reduce HARVIs. Interventions primarily focused on improving FVHH and reducing visitation by symptomatic family members and visitors. We defined correct FVHH as hand hygiene performed immediately before touching their child. Hand hygiene observations were performed by direct observation by NICU staff using a standardized tool. Interventions to improve FVHH included education of staff and visitors, reminder signs, and immediate reminders to families to prevent lapses in hand hygiene. Staff screened family and visitors before NICU entry. Symptomatic individuals were asked to defer visitation until symptoms resolved. HARVIs were identified during prospective surveillance by infection preventionists using standard definitions.

Results: Baseline FVHH was 27% in 2015. After May 2017, the average FVHH remained at 85%. When reminded, family members and visitors performed hand hygiene 99% of the time. Staff screened ~129,000 people for FVHH. Between January 2013 and March 2019, there were 74 HARVIs; 80% were rhinovirus/enterovirus. After the implementation of improved FVHH, the HARVI rate decreased from 0.67 to 0.23/1,000 patient days.

Conclusions: Adding interventions to improve FVHH and visitor management to existing healthcare worker prevention efforts can help reduce HARVIs in the NICU.

Fig. 1.

Run chart showing the percentage of families and visitors performing hand hygiene immediately before touching their child in the neonatal intensive care unit by month from August 2015 to March 2019.

Fig. 2.

Statistical process control chart showing the rate of HARVIs per 1,000 patient days in the NICU by month from January 2013 to March 2019. Upper and lower control limits set 3 standard deviations from the mean.

Fig. 3.

The number of RPP assays ordered in the NICU by month between January 2013 and March 2019.

Fig. 4.

The distribution of all respiratory pathogens detected by the hospital’s RPP assay by month between February 2012 and March 2019. Adno, adenovirus; HKU1, coronavirus HKU1; HMPV, human metapneumovirus; NL63, coronavirus NL63; RHN/ENV, human rhinovirus/enterovirus; 2009, influenza A 2009 H1N1; H1, influenza A H1N1; H3, influenza A H3N2; FLUB, influenza B; PIV1, parainfluenza 1; PIV2, parainfluenza 2; PIV3, parainfluenza 3; PIV4, parainfluenza 4; RSV, respiratory syncytial virus A; 229E, coronavirus 229E; OC43, coronavirus OC43; BPRVP, Bordetella pertussis; BparaRVP, Bordetella parapertussis; CHLPNEU, Chlamydophila pneumonia; MYCO, Mycoplasma pneumoniae.