Levy, Emily

Background: Measles is a highly transmissible virus. A single case can result in significant exposures within a healthcare facility and prompt action is needed to prevent secondary cases. In October 2025, Infection Prevention and Control (IPAC) was notified of a patient being admitted to our facility with recent international travel and symptoms consistent with measles. The patient was unvaccinated and had five healthcare facility visits prior to measles being suspected and subsequently confirmed. Objective: To describe our facility’s effective identification, prioritization, and prophylaxis of individuals exposed to measles. Methods: IPAC leveraged the electronic medical record to identify potentially exposed patients. Patients were quickly assessed for age and immune status, then prioritized and assigned to primary care teams. These teams promptly contacted patients and coordinated PEP administration. Results: Across five encounters, the index patient exposed 539 other patients. Due to delayed notification, our teams had less than four days to administer PEP for those exposed and still within PEP window. PEP administration began within hours of the index case’s positive test and patients received PEP within three days (Table 1). No secondary measles cases occurred within our facility. Conclusion: Timely and coordinated multidisciplinary effort enabled us to rapidly respond to our first measles case and control secondary transmission. Although the index case resulted in a large exposure, patients that were exposed and eligible for PEP were quickly prioritized to prevent secondary transmission.

Background: Advanced planning and adaptable response strategies are essential for preventing measles transmission in healthcare facilities. Objective: To describe a measles management plan and subsequent modifications in response to a cluster of measles cases. Methods: Drawing on previously published work (doi:10.1017/ice.2025.49), the Infection Prevention and Control (IPAC) team initiated a multi-disciplinary team and developed a measles preparedness plan with the following domains: Guidance and education; early detection and testing; isolation and patient movement; contact tracing and exposure management (Table 1). In October 2025, a patient was admitted during their fifth healthcare encounter and was diagnosed with measles. Two family members were later hospitalized with measles. Delayed recognition of the first case prompted enhancements to our preparedness framework (Table 1). Results: The first case resulted in 539 exposed patients. The second resulted in 87 exposures, and the third resulted in no exposure. Despite the extensive exposure, zero secondary measles were reported. Conclusion: Proactive planning enabled rapid response to our first case and controlled secondary transmission. Despite extensive planning, delayed identification of the first case caused significant exposures. As the cluster unfolded, we refined our plan, resulting in zero exposures from the last patient and zero secondary cases, despite over 850 exposures. These efforts may guide other healthcare facilities in improving their measles preparedness and response.

Background: Central line-associated bloodstream infections (CLABSIs) remain a challenge in pediatric intensive care units (PICUs); central line days have been directly correlated with risk of CLABSI. The Mayo Clinic PICU is a 23-bed multidisciplinary unit including dedicated bone marrow transplant beds with an average of 1048 admissions annually. In 2024, the unit’s CLABSI rate was 0.82 per 1,000 central line days or approximately 1–3 CLABSIs per year. Weekly multidisciplinary CLABSI Prevention Rounds were piloted from August 2024 to March 2025 with the aim of reducing central line device utilization rate as a method to reduce CLABSI risk. Methods: A multidisciplinary team of Clinical Nurse Specialists (CNS), Nurse Managers, and off-service PICU physicians conducted weekly CLABSI rounds on PICU beds (excluding 4 BMT beds), meeting with each bedside nurse as well as the on-service providers. The CLABSI team assessed central line necessity using a standard questionnaire and provided education to physicians and nurses regarding central line care and CLABSI prevention. Monthly data were compared for the same 8 calendar months pre versus post intervention for central line days, patient days, and device utilization rate (DUR; central line days/patient days), both unadjusted and adjusted for PRISM (Pediatric Risk of Mortality) 3 severity of illness score. Pre- and post-implementation staff surveys assessed confidence in line management and interdisciplinary communication using Likert scales. Results: Thirty-two CLABSI rounds with a total of 118 individual patients and 45 discrete interventions were noted over 8 months and compared to the 8 pre-intervention corresponding months. Pre versus post monthly DUR was 0.42 [0.32–0.57] vs 0.46 [0.30–0.55], p = 0.49 (PRISM 3–adjusted p = 0.97). Nursing confidence in ‘discussing central line need’ significantly improved post-implementation, 5 [4–5] vs 5 [5–5], p = 0.035. Nurses also positively perceived third-party involvement in need assessment, 4 [3–4] vs 4 [3–4], p = 0.06. All surveyed clinicians trended toward being less likely to think a central line was left in too long, 3 [3–4] vs 3 [2–4], p = 0.06. Conclusion: Structured weekly multidisciplinary CLABSI rounds are a feasible intervention that empowers bedside nurses and improves confidence in line maintenance and interdisciplinary communication. Median DUR was not significantly altered by the intervention, but nursing perception of central line management improved qualitatively in pre- versus post-implementation surveys. Continued expansion of multidisciplinary initiatives addressing central line necessity and management is needed to further evaluate overall effects on DUR and CLABSI incidence.

A 10-year-old girl with a past medical history significant for prematurity at 29 weeks, short bowel syndrome secondary to necrotizing enterocolitis, prior episodes of small intestinal bacterial overgrowth complicated by D-lactic acidosis, and gastric tube dependence presented to an emergency department with emesis, slurred speech, somnolence, and unsteady gait. Workup was initiated, and she was started on broad-spectrum antibiotics and transferred to our pediatric intensive care unit for further evaluation and treatment. Differential diagnosis on admission was broad, and, through thorough laboratory evaluation, imaging, and multiple subspecialty inputs, an unusual diagnosis was confirmed.

OBJECTIVE To describe the impact of obesity on disease severity and outcomes of coronavirus disease 2019 (COVID-19) among hospitalized children. METHODS This retrospective cohort study from the Society of Critical Care Medicine Viral Respiratory Illness Universal Study registry included all children hospitalized with COVID-19 from March 2020 to January 2021. Obesity was defined by Centers for Disease Control and Prevention BMI or World Health Organization weight for length criteria. Critical illness definition was adapted from National Institutes of Health criteria of critical COVID. Multivariate mixed logistic and linear regression was performed to calculate the adjusted odds ratio of critical illness and the adjusted impact of obesity on hospital length of stay. RESULTS Data from 795 patients (96.4% United States) from 45 sites were analyzed, including 251 (31.5%) with obesity and 544 (68.5%) without. A higher proportion of patients with obesity were adolescents, of Hispanic ethnicity, and had other comorbidities. Those with obesity were also more likely to be diagnosed with multisystem inflammatory syndrome in children (35.7% vs 28.1%, P = .04) and had higher ICU admission rates (57% vs 44%, P < .01) with more critical illness (30.3% vs 18.3%, P < .01). Obesity had more impact on acute COVID-19 severity than on multisystem inflammatory syndrome in children presentation. The adjusted odds ratio for critical illness with obesity was 3.11 (95% confidence interval: 1.8–5.3). Patients with obesity had longer adjusted length of stay (exponentiated parameter estimate 1.3; 95% confidence interval: 1.1–1.5) compared with patients without obesity but did not have increased mortality risk due to COVID-19 (2.4% vs 1.5%, P = .38). CONCLUSION In a large, multicenter cohort, a high proportion of hospitalized children from COVID-19 had obesity as comorbidity. Furthermore, obesity had a significant independent association with critical illness.