TY - JOUR
T1 - Early Extended Neonatal Screening for Congenital Cytomegalovirus Infection
T2 - A Quality Improvement Initiative
AU - Krishna, Sunil
AU - Nemerofsky, Sheri L.
AU - Iyare, Abieyuwa
AU - Ramdhanie, Mahindra A.
AU - Nassar, Michel
AU - Nafday, Suhas
N1 - Publisher Copyright:
© 2020 The Joint Commission
PY - 2020/9
Y1 - 2020/9
N2 - Background: Identification of congenital cytomegalovirus (cCMV) infection in neonates is important for early diagnosis of sensorineural hearing loss. Therefore, a quality improvement project was designed with an aim to improve newborn CMV screening by 25% from a baseline rate of 22%. Methods: This project was conducted across two hospital sites at one medical center with two tertiary care newborn nurseries and neonatal intensive care units. Symptomatic neonates with suggestive findings of cCMV, who had failed the newborn hearing screen, who had not had a hearing screen performed by 10 days of age, or who were infants of HIV-positive mothers were screened for cCMV. Serial interventions (formalized teaching sessions using an algorithm and involving a nurse educator, creation of electronic medical record order sets, huddle board reminders, and regular audits) were conducted, and statistical process control p-charts were used to identify any signals and to determine if there was any special cause variation. Results: Of 5,817 infants born in 2018, 903 were eligible for screening. Small for gestational age (46%) was the most common indication for screening. After multiple interventions, the median screening rate increased from a baseline of 22% in 2016 to 74% during the one-year study period. Four infants had positive CMV screen and received appropriate treatment as a result of these interventions. Conclusion: Multidisciplinary quality improvement initiatives can improve newborn screening for cCMV infection in a tertiary care environment.
AB - Background: Identification of congenital cytomegalovirus (cCMV) infection in neonates is important for early diagnosis of sensorineural hearing loss. Therefore, a quality improvement project was designed with an aim to improve newborn CMV screening by 25% from a baseline rate of 22%. Methods: This project was conducted across two hospital sites at one medical center with two tertiary care newborn nurseries and neonatal intensive care units. Symptomatic neonates with suggestive findings of cCMV, who had failed the newborn hearing screen, who had not had a hearing screen performed by 10 days of age, or who were infants of HIV-positive mothers were screened for cCMV. Serial interventions (formalized teaching sessions using an algorithm and involving a nurse educator, creation of electronic medical record order sets, huddle board reminders, and regular audits) were conducted, and statistical process control p-charts were used to identify any signals and to determine if there was any special cause variation. Results: Of 5,817 infants born in 2018, 903 were eligible for screening. Small for gestational age (46%) was the most common indication for screening. After multiple interventions, the median screening rate increased from a baseline of 22% in 2016 to 74% during the one-year study period. Four infants had positive CMV screen and received appropriate treatment as a result of these interventions. Conclusion: Multidisciplinary quality improvement initiatives can improve newborn screening for cCMV infection in a tertiary care environment.
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U2 - 10.1016/j.jcjq.2020.06.002
DO - 10.1016/j.jcjq.2020.06.002
M3 - Article
C2 - 32690465
AN - SCOPUS:85088127998
SN - 1553-7250
VL - 46
SP - 516
EP - 523
JO - Joint Commission Journal on Quality and Patient Safety
JF - Joint Commission Journal on Quality and Patient Safety
IS - 9
ER -