A quality improvement project successfully improved the number of infants aged 0 to 60 days who were treated for herpes simplex virus according to guideline recommendations, and it decreased the number of infants receiving treatment with acyclovir who were not high risk.
Laura H. Brower, MD, an attending physician in the division of hospital medicine at Cincinnati Children’s Hospital and an assistant professor at the University of Cincinnati, and colleagues wrote that identifying HSV in a timely manner can be difficult because manifestations can differ from infant to infant and include nonspecific signs such as hypothermia and decreased feeding.
“This variability in presentation can lead to delayed recognition of HSV and delayed initiation of acyclovir therapy, which is associated with a significantly higher odds of mortality,” the researchers wrote. “However, testing and empirically treating every febrile neonate with acyclovir regardless of symptomology is not cost-effective and may lead to medication-related side effects, including acute kidney injury and extravasation injury.”
Brower and colleagues conducted the study at a freestanding children’s hospital. The project included interventions focused on provider buy-in, guideline availability and identifying high-risk patients accurately. These changes were promoted through educating frontline providers and making sure guidelines were accessible in point-of-care settings. Later, the hospital’s electronic health system in the ED was adjusted to allow physicians to opt out of following recommendations and providing education at that point.
Within 8 months, the number of infants managed with guideline-recommended treatment increased from 40% to 80%. Additionally, the number of infants who were not high risk who received acyclovir decreased from 26% to 7.9% (P < .001). The use of the drug in high-risk patients did not change significantly during the study period (73% to 83%).
Brower and colleagues did not observe any delays in starting acyclovir in infants with HSV during the study.
“Because of the potential changing epidemiology of neonatal HSV, we will continue to follow patient outcomes, including delayed acyclovir initiation and missed cases of HSV to monitor the safety of guideline recommendations,” the researchers wrote. – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.