Nosocomial exposure of health care workers to a visitor with active pulmonary tuberculosis in a pediatric intensive care unit: A contact investigation.

Visitors with active tuberculosis (TB) can lead to uncontrolled introductions in health care settings, even in facilities with robust TB control programs. We report a pediatric case of TB meningitis who had an adult visitor with active pulmonary TB. We identified 96 contacts from the index case. One high-risk contact had a positive follow-up TB test with no clinical symptoms. TB control programs should incorporate the risk of TB exposure from adult visitors, especially in pediatric settings.

Improving transitions of care between the operating room and intensive care unit.

Transitions of care between individual providers or teams of providers have a high potential for errors due to the incomplete transfer of critical information and the need for ongoing care. The transition from the operating room (OR) to the intensive care unit (ICU) is a particularly dangerous time for critically ill children. Hand-offs of care between the OR and ICU teams during this key transition period require detailed communication of complete and accurate patient information at a time when the patient is perhaps most vulnerable from a physiologic standpoint. Improving the safety of transitions from the OR to the ICU is an active area of investigation, though there are a few notable best practices that are commonly employed in a number of centers. These best practices include having the appropriate personnel at the bedside for the hand-off, the use of scripts and the "sterile cockpit rule", the use of checklists, double verification of post-operative orders, and maintaining an overall safety culture.

Promoting Staff Resilience in the Pediatric Intensive Care Unit.

BACKGROUND: Health care professionals experience workplace stress, which may lead to impaired physical and mental health, job turnover, and burnout. Resilience allows people to handle stress positively. Little research is aimed at finding interventions to improve resilience in health care professionals. OBJECTIVE: To describe the availability, use, and helpfulness of resilience-promoting resources and identify an intervention to implement across multiple pediatric intensive care units. METHODS: A descriptive study collecting data on availability, utilization, and impact of resilience resources from leadership teams and individual staff members in pediatric intensive care units, along with resilience scores and teamwork climate scores. RESULTS: Leadership teams from 20 pediatric intensive care units completed the leadership survey. Individual surveys were completed by 1066 staff members (51% response rate). The 2 most used and impactful resources were 1-on-1 discussions with colleagues and informal social interactions with colleagues out of the hospital. Other resources (taking a break from stressful patients, being relieved of duty after your patient's death, palliative care support for staff, structured social activities out of hospital, and Schwartz Center rounds) were highly impactful but underused. Utilization and impact of resources differed significantly between professions, between those with higher versus lower resilience, and between individuals in units with low versus high teamwork climate. CONCLUSIONS: Institutions could facilitate access to peer discussions and social interactions to promote resilience. Highly impactful resources with low utilization could be targets for improved access. Differences in utilization and impact between groups suggest that varied interventions would be necessary to reach all individuals.