Survey of Infection Control Precautions for Patients with Severe Combined Immune Deficiency
CPS ePoster Library. Rogers B. 06/25/15; 99250; 189
Brieanne Rogers
Brieanne Rogers
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Abstract
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Background: Severe combined immune deficiency (SCID) is caused by an array of genetic disorders resulting in an impaired adaptive immune system. It usually presents within the first few months of life with multiple or chronic infections as the production and function of T lymphocytes and/or B lymphocytes are extremely impaired or absent. To prevent transmission of infections in SCID patients, standardized infection control precautions and guidelines should be implemented. Although infection control policies have been described for other vulnerable pediatric populations such as hematopoietic stem cell transplant and oncology patients, SCID-specific infection control policies have not yet been described, and we have noted SCID-specific policies vary significantly between centers. This study aims to describe SCID-specific infection control protocols internationally, and from this descriptive data, future evidence-based research into effective SCID infection control practices can be proposed.
Methods: A survey regarding SCID-specific isolation protocols was disseminated online by Immunodeficiency Canada and the Clinical Immunology Society. Descriptive data was collected and analyzed. This research was approved by our local Research and Ethics Board, and participant consent was discussed at the beginning of the survey.
Results: A total of seventy-three responses were obtained. The majority of respondents were from the United States (54%), followed by 14% from Canada, and the remainder were from 14 other countries. Most respondents were HSCT specialists (44%) or physicians working with HSCT patients (36%). The majority of centers had 1-5 SCID patients (77%).
Only 50% of respondents noted that their center had a SCID-specific infection control protocol. Most doctors (88%) received training on these protocols, but only 54% of nurse practitioners and 46% of nurses received training. Less than one third reported training other professionals such as other allied health workers and housekeepers (32% and 30 % respectively). Only 30% of respondents reported a formal compliance assessment program for these protocols.
For inpatients, the vast majority are admitted to one bedroom rooms (89%) with HEPA filters present in 51% of rooms, positive pressure air flow in 41%, laminar air flow in 19%, and anterooms in 55%. Required personal protective equipment (PPE) for staff included non-sterile gowns (66%), a surgical mask (72%) and non-sterile gloves (62%). Some centers required sterile gloves (9%) and gowns (14%) as well as hair (22%) and shoe covers (19%). Nearly half (48%) of respondents do not require caregivers to wear any PPE. Most centers (62%) allow visitors, however all centers except one had visitor restriction such as number of visitors and age of children.
Guidelines for breastfeeding varied: 16% of respondents do not allow breastfeeding or expressed breast milk at all, 50% allow it if the mother is CMV negative, and some centers process expressed milk with irradiation, pasteurization or freezing it.
There was significant variability with regard to indications for discharge of a clinically well child with SCID. Nearly one third of respondents (31%) would not discharge a SCID patient home regardless of clinical status. The remainder would allow clinically well SCID babies to be home under various conditions, such as requiring that the family live close by (31%) and no visitors are allowed (33%). Eleven percent of respondents had no restrictions for discharge of clinically well SCID patients.
Conclusions: Significant variability was found with regard to SCID-specific infection control precautions at different treatment centers. There was disagreement as to whether a well child with SCID should be cared for as an inpatient, or if it is safe for them to go home. For inpatients, the type of PPE required by staff and caregivers, and whether visitors are allowed varied. Conditions for allowing breastfeeding were discordant between centers. And finally, many centers did not have a SCID-specific infection control protocol at all, and most had no formal compliance program. There is little evidence-based data regarding what environment is safest to prevent infection in a child with SCID, and it must be considered that some of the protocols that are instituted may have significant impact on infection risk, family well-being, the child’s development and cost of care. Further multi-center research is needed in this area to determine the safest and healthiest environment for these children.
Background: Severe combined immune deficiency (SCID) is caused by an array of genetic disorders resulting in an impaired adaptive immune system. It usually presents within the first few months of life with multiple or chronic infections as the production and function of T lymphocytes and/or B lymphocytes are extremely impaired or absent. To prevent transmission of infections in SCID patients, standardized infection control precautions and guidelines should be implemented. Although infection control policies have been described for other vulnerable pediatric populations such as hematopoietic stem cell transplant and oncology patients, SCID-specific infection control policies have not yet been described, and we have noted SCID-specific policies vary significantly between centers. This study aims to describe SCID-specific infection control protocols internationally, and from this descriptive data, future evidence-based research into effective SCID infection control practices can be proposed.
Methods: A survey regarding SCID-specific isolation protocols was disseminated online by Immunodeficiency Canada and the Clinical Immunology Society. Descriptive data was collected and analyzed. This research was approved by our local Research and Ethics Board, and participant consent was discussed at the beginning of the survey.
Results: A total of seventy-three responses were obtained. The majority of respondents were from the United States (54%), followed by 14% from Canada, and the remainder were from 14 other countries. Most respondents were HSCT specialists (44%) or physicians working with HSCT patients (36%). The majority of centers had 1-5 SCID patients (77%).
Only 50% of respondents noted that their center had a SCID-specific infection control protocol. Most doctors (88%) received training on these protocols, but only 54% of nurse practitioners and 46% of nurses received training. Less than one third reported training other professionals such as other allied health workers and housekeepers (32% and 30 % respectively). Only 30% of respondents reported a formal compliance assessment program for these protocols.
For inpatients, the vast majority are admitted to one bedroom rooms (89%) with HEPA filters present in 51% of rooms, positive pressure air flow in 41%, laminar air flow in 19%, and anterooms in 55%. Required personal protective equipment (PPE) for staff included non-sterile gowns (66%), a surgical mask (72%) and non-sterile gloves (62%). Some centers required sterile gloves (9%) and gowns (14%) as well as hair (22%) and shoe covers (19%). Nearly half (48%) of respondents do not require caregivers to wear any PPE. Most centers (62%) allow visitors, however all centers except one had visitor restriction such as number of visitors and age of children.
Guidelines for breastfeeding varied: 16% of respondents do not allow breastfeeding or expressed breast milk at all, 50% allow it if the mother is CMV negative, and some centers process expressed milk with irradiation, pasteurization or freezing it.
There was significant variability with regard to indications for discharge of a clinically well child with SCID. Nearly one third of respondents (31%) would not discharge a SCID patient home regardless of clinical status. The remainder would allow clinically well SCID babies to be home under various conditions, such as requiring that the family live close by (31%) and no visitors are allowed (33%). Eleven percent of respondents had no restrictions for discharge of clinically well SCID patients.
Conclusions: Significant variability was found with regard to SCID-specific infection control precautions at different treatment centers. There was disagreement as to whether a well child with SCID should be cared for as an inpatient, or if it is safe for them to go home. For inpatients, the type of PPE required by staff and caregivers, and whether visitors are allowed varied. Conditions for allowing breastfeeding were discordant between centers. And finally, many centers did not have a SCID-specific infection control protocol at all, and most had no formal compliance program. There is little evidence-based data regarding what environment is safest to prevent infection in a child with SCID, and it must be considered that some of the protocols that are instituted may have significant impact on infection risk, family well-being, the child’s development and cost of care. Further multi-center research is needed in this area to determine the safest and healthiest environment for these children.
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