Pediatric patients in long-term care facilities are at high risk of pathogen transmission due to multibed bedrooms, common eating areas, and an on-site school. Therefore, identifying the risk factors for common infections, like respiratory tract infections, is important to establish evidence-based strategies to reduce and control pathogen transmission.
Pediatric patients discharged from acute care hospitals are often directed to pediatric long-term care facilities (pLTCFs), where they are taken care of for a longer length of time. The number and complexity of patients in these facilities are rapidly increasing. Consequently, pLTCFs require a substantial amount of health care resources and money to effectively operate. A major problem in long-term care facilities, particularly for pediatric and geriatric patients, is infection. Understanding the incidence, type, and rate of infection is vital for developing evidence-based strategies to help reduce the risk of infections in these populations.
A recent prospective study, published in JAMA Pediatrics, was conducted to investigate infections in a population of pediatric patients requiring long-term care. The current study was part of a larger study called Keep It Clean for Kids (KICK), which aimed to reduce infections in pLTCFs. The authors recruited 717 residents aged 21 years or younger from three different sites in the United States and followed them over the course of three years. Over the study period, authors investigated the incidence, rate, and type of infections. Additionally, they investigated risk factors for infection in this population, in hopes of developing prophylactic strategies.
The study found that the most common chronic comorbid conditions were musculoskeletal or ambulation, neurologic, respiratory, and gastrointestinal disorders. Interestingly, the type of chronic comorbidity differed between the three different sites investigated. There were 2,052 infections diagnosed over the three-year study period, of which respiratory tract infections (RTIs), otitis/conjunctivitis, and skin and soft-tissue infections were the most common. In contrast, previous studies have shown that urinary tract infections (UTIs) and pneumonia are the most common types of infections in hospitalized adults and children, respectively. The study also reported a total of 62 infection outbreaks over the study period, affecting a total of 819 residents. The most common causes of outbreaks were respiratory viruses, including the rhinovirus and enterovirus. Finally, the authors identified younger age, an increased number of chronic comorbid conditions, and the presence of devices (like feeding tube or tracheostomy) as significant risk factors for respiratory tract infections.
The nature of pLTCFs, like multibed bedrooms, common eating areas, on-site schools, are all factors that contribute to the risk of pathogen transmission. Developing evidence-based strategies to prevent and reduce the risk of infection is of upmost importance to health care professions and their patients. The current study emphasizes this fact, and identifies respiratory infections as the most common infection risk, in pediatric patients. They also demonstrate that age, chronic comorbid conditions, and the presence of devices are risks for respiratory tract infections, but failed to identify significant patient risk factors. Significant differences between infection rates were observed between the different sites, indicating that other factors, like site infrastructure, architecture, and/or infection prevent and control strategies, could be modifying risk factors. Moving forward, researchers should attempt to identify these unknown factors and establish more appropriate strategies to reduce the risk of pathogen transmission and infection.
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.
