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Keep It Clean for Kids: The KICK Project

Principal Investigators

Elaine Larson, PhD, RN, CIC, FAAN
Professor of Therapeutic and Pharmaceutical Research
Columbia University School of Nursing
Lisa Saiman, MD, MPH
Professor of Clinical Pediatrics
Department of Pediatrics, College of Physicians & Surgeons of Columbia University

Project Summary

Funder: Agency for Healthcare Research and Quality (AHRQ)
Grant: R01HS021470
Dates: July 1, 2012 through June 30, 2016
Funding: $1,656,379

Healthcare-associated infections (HAIs) are the leading cause of morbidity and mortality in long term care facilities (LTCF), and are responsible for nearly 400,000 deaths each year in this population. Children in pediatric LTCF represent a highly vulnerable patient population with numerous comorbid conditions (most often neurologic and chronic lung diseases), at high risk of contracting HAIs caused by multidrug-resistant organisms as well as by viral pathogens. Numerous types of care givers provide medical care, rehabilitation services, education, recreational therapy, and leisure activities to these children. Unfortunately, these unique host and institutional factors can facilitate transmission of infectious agents among patients as well as staff. Outbreaks occur frequently, resulting in significant morbidity, mortality, resource use, and cost. In addition, changes to healthcare delivery for children have resulted in increased acuity and device use (e.g., tracheostomies, central venous catheters, and feeding tubes) among children in pediatric LTCF. HAIs acquired in pediatric LTCF may require increased levels of care (e.g., ventilator support) and transfer to acute care facilities with the resultant risk of further transmission of drug-resistant bacteria and viral pathogens.

Although HAIs have been the focus of mainstream media attention, little empirical has been conducted to prevent HAIs in LTCF, particularly in pediatric LTCF. Hand hygiene (HH) is a prominent example of a potentially effective infection prevention practice for HAIs, but HH practices remain dismal across the spectrum of healthcare. As evidence, a large number of strategies have been implemented in acute care facilities and generally resulted in only small, incremental improvements that were often not sustained over time.

Experts agree that sustained meaningful improvements in HH require integration of HH practice improvement within the larger context of a patient safety climate. A formalized program to reduce HAIs by rooting HH practices within the overall organizational culture originated almost two decades ago in Geneva and led the World Health Organization (WHO) to disseminate a global HH guideline with associated toolkits and enablers to facilitate implementation of core components of a patient safety climate. This guideline has been adopted and adapted in multiple countries in both the developed and developing world but has not yet been adapted for pediatric LTCF. The goal of this study was to reduce HAIs in pediatric LTCF by improving infection prevention practices using active staff involvement and a systematic, planned, generalizable process.



Saiman L, Maykowski P, Murray M, Cohen B, Neu N, Jia H, Hutcheon G, Simpser E, Mosiello L, Alba A, Larson E.  Epidemiology of infections in pediatric long-term care facilities. JAMA Pediatrics 2017.  Epub ahead of print.


Hessels AJ, Agarawal M, Larson EL. Measuring Patient Safety Culture in Pediatric Long-term Care. Journal of Pediatric Rehabilitation Medicine 2017;10:81-87.


Larson E, Murray M, Cohen B, Simpser E, Pavia M, Jackson O, Jia H, Hutcheon G, Mosiello L, Alba L, Neu N, Saiman L.  Reducing Infections in Pediatric Long-term Care Facilities:  The Keep It Clean for Kids (KICK) Intervention Trial.  Behavioral Medicine 2017;43:1-10.


Cohen B, Murray M, Jia H, Jackson O, Saiman L, Neu N, Hutcheon G, Larson E.  Is Hand Hygiene Frequency Associated with the Onset of Outbreaks in Pediatric Long-Term Care?  American Journal of Infection Control 2016;44:1492-1494. 


Hessels A, Murray M, Cohen B, Larson E. Patient Safety Culture Survey in Pediatric Complex Care Settings: A Factor Analysis.  Journal of Patient Safety 2017. [Epub ahead of print.]


Navarra AM, Schlau R, Murray M, Mosiello L, Schneider L, Jackson O, Cohen B, Saiman L, Larson E.  Assessing Nursing Care Needs of Children with Complex Medical Conditions: The Nursing Kids Intensity of Care Survey (N-KICS). Journal of Pediatric Nursing 2016;31:299-310.


Loyland B, Wilmont S, Hessels A, Larson E.  Staff knowledge, awareness, perceptions and beliefs about infection prevention in pediatric long-term care facilities.  Nursing Research 2016;65:132-141. 


Murray M, Heitkemper E, Jackson O, Neu N, Stone P, Cohen B, Saiman L, Hutcheon G, Larson E.  Direct Costs of Acute Respiratory Infections in a Pediatric Long Term Care Facility.  Influenza and Other Respiratory Viruses 2016;10:34-6. 


Murray MT, Jackson O, Cohen B, Hutcheon G, Saiman L, Larson E, Neu N.  Impact of Infection Prevention and Control Initiatives on Acute Respiratory Infections in a Pediatric Long-term Care Facility.  Infection Control and Hospital Epidemiology 2016;37:859-62. 


Loyland B, Wilmont S, Cohen B, Larson E.  Hand hygiene practices and observed barriers in pediatric long-term care facilities in the New York metropolitan area.  International Journal for Quality in Health Care 2016;28:74-80. 


Murray MT, Pavia M, Jackson O, Keenan M, Neu NM, Cohen B, Saiman L, Larson EL.  Health care-associated infection outbreaks in pediatric long-term care facilities.  American Journal of Infection Control 2015;43:756-8. 


Murray M, Neu N, Cohen B, Hutcheon G, Simpser E, Larson E, Saiman L.  Developing Case Definitions for Healthcare-associated Infections for Pediatric Long Term Care Facilities.  Clinical Pediatrics 2015;54:1380-2. 


Carter EJ, Cohen B, Murray MT, Saiman L, Larson E.  Using Workflow Diagrams to Address Hand Hygiene in Pediatric Long-Term Care Facilities.  Journal of Pediatric Nursing 2015;30:e17-21.


Murray M, Cohen B, Neu N, Hutcheon G, Simpser E, Larson E, Saiman L.  Infection Prevention and Control Practices in Pediatric Long Term Care Facilities. American Journal of Infection Control 2014;42:1233-4. 


Larson E, Cohen B, Murray M, Saiman L.  Challenges in Conducting Research in Pediatric Long Term Care Facilities.  Clinical Pediatrics 2014;53(11):1041-6. 


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 2013;28(1):72-6.