Columbia’s Nursing School Launches "Keep It Clean for Kids" (KICK)

Source: Columbia University School of Nursing

Columbia University School of Nursing has received a $1.2 million grant to research and improve infection prevention practices in pediatric long-term care facilities.  The four-year grant from the Agency for Healthcare Research and Quality (AHRQ) will enable researchers to undertake the "Keep It Clean for Kids" Project, or KICK, a study assessing hand hygiene at three New York-area facilities that care for children with complex health conditions and disabilities.

Children in pediatric long term care facilities account for forty percent of medical expenditures for children overall, and are at especially high risk of contracting such health-care associated infections (HAIs) as MRSA, influenza, and hepatitis A.  This is the first study of its kind to provide information about the rates and types of infection in these children and test if the KICK intervention can reduce these infections.  The project will be headed by Elaine Larson, RN, PhD, Professor of Pharmaceutical and Therapeutic Research and Associate Dean for Research at Columbia University School of Nursing, and Lisa Saiman, MD, MPH, Professor of Clinical Pediatrics at Columbia University Medical Center and Hospital Epidemiologist at Morgan Stanley Children's Hospital of New York-Presbyterian.

"The goal of this study is to reduce HAIs in pediatric long term care facilities with a tailored intervention that combines innovative technology, active participation of leadership and staff, continuous workflow assessments and feedback," said Dr. Larson. "We want to change the patient safety culture so that the benefits of KICK are sustainable and transferable to other pediatric long term care facilities."

The three study sites are: St. Mary's Healthcare System for Children (Bayside, NY), Sunshine Children's Home and Rehab Center (Ossining, NY), and Elizabeth Seton Pediatric Center (New York, NY).  Combined, the sites care for approximately 284 children, from newborn to 21 years old, the majority of whom are dependent on staff for almost all their care.

The KICK Project has five key components which involve the active participation of leadership and of staff, assessing work flow, training staff in the World Health Organization's "Five Moments for Hand Hygiene," and the electronic monitoring and feedback of hand hygiene.

Ultimately, the program aims to create a culture change in which all staff 'own' the problem of HAIs in their patients, internalize the need for hand hygiene and other precautions to prevent these infections, create their own solutions, and promulgate these solutions throughout the facilities.

A 2011 study* conducted by Columbia in partnership with DebMed, a Charlotte, NC hand hygiene technology company,  revealed low rates of hand hygiene compliance across various pediatric long-term care facilities. Building on that, the KICK program study will incorporate the DebMed GMS (group monitoring system) to provide real time data and feedback to staff about their hand hygiene performance.

The DebMed GMS is a real-time electronic hand hygiene monitoring system that measures compliance based on the World Health Organization's "Five Moments for Hand Hygiene." A web based application then allows 24x7 access to dashboards and reports enabling the three facilities in the KICK study to monitor their hand hygiene compliance and continue to educate their staff on how they can play a role in working towards eliminating HAIs by improving their performance.

"Prevention of HAIs among children in pediatric long-term care facilities has not been well-studied," said Dr. Saimon.  "Infection prevention efforts involved in this study will extend beyond traditional clinical staff to include teachers, families, and hospital volunteers and, if successful, can be adopted by other clinical settings such as family-centered care, pediatric and adult acute care, and day care."

*Buet, A., Cohen, B., Marine, M., Scully, F., Alper, P., Simpser, E., Saiman, L., Larson, E. Hand Hygiene Opportunities in Pediatric Extended Care Facilities. Journal of Pediatric Nursing (2012)

Columbia University School of Nursing is part of the Columbia University Medical Center, which also includes the College of Physicians & Surgeons, the Mailman School of Public Health, and the College of Dental Medicine.  With more than 100 full-time faculty and 600 students, the School of Nursing is dedicated to training the next generation of nurse leaders in education, research, and clinical care. The School has pioneered advanced practice nursing curricula and continues to redefine the role of nurses through its PhD program which prepares nurse scientists, and its Doctor of Nursing Practice (DNP), the first clinical practice doctorate in the nation. Among the clinical practice areas shaped by the School’s research are the reduction of infectious disease and the use of health care informatics to improve health and health care. For more information, please visit: www.nursing.columbia.edu.