#30: Coronavirus Disease 2019 (COVID-19) Incidence in Pediatric Oncology Patient: Does Routine Screening Affect the Risk for the Transmission in the Hospital

Background Cancer patients are at higher risk of COVID-19 infection and more likely they have higher morbidity and mortality than the general population. On the other hand, the oncology patient sometimes can show asymptomatic COVID-19 disease with a risk of longer viral shedding and spreading the infection to others immunosuppressed individuals. Oncology patients also regularly travel between hospital and sometimes lodge in boarding house for routine chemotherapy. As we known, prevention strategy for COVID-19 among pediatric oncology patients can be implemented by minimizing these risks factors for transmission by identifying all patients infected with COVID-19. Here, we report our experience before and after implementing COVID-19 testing policy of patients with hematology and oncology diseases in our center. Method We collected data of pediatric oncology patients admitted to Hasan Sadikin General hospital between July 1st, 2020 to January 8th, 2021. The data consisted of the total number of patients and COVID-19 status by using SARS-CoV-2 Nucleic Acid Amplification Test (NAAT) performed in the patient during two periods. In the first period, we performed NAAT if the patient was suspected of COVID-19. In the second period, after the policy was changed, NAAT was performed routinely as screening for all oncologic patients admitted to the hospital. Results Between July 1st to December 2nd, 2020, the first period, there was 3 positive results from 36 suspected COVID-19 patients among 181 total pediatric oncology patients. In the second period, we found 8 positive results from 121 hospitalized patients, none of them had signs and symptoms of COVID-19; and 4 of them came from boarding house. Conclusion Routine screening for COVID-19 should be considered as a policy for hospitalization of a pediatric oncology patient because of the high risk that asymptomatic COVID-19 patients can transmit the infection to other patient and to health care workers in the hospital.

Clinician Emotions Surrounding Pediatric Oncology Patient Deterioration

BackgroundPediatric oncology patients have a high rate of clinical deterioration frequently requiring critical care. Patient deterioration events are distressing for clinicians, but little is known about how Pediatric Early Warning Systems (PEWS) impact clinicians’ emotional responses to deterioration events.MethodsSemi-structured interviews were conducted with 83 nurses, pediatricians, oncologists, and intensive care clinicians who had recently participated in a patient deterioration event at two pediatric oncology hospitals of different resource-levels: St. Jude Children’s Research Hospital (N = 42 participants) in Memphis, Tennessee or Unidad Nacional de Oncología Pediátrica (N = 41 participants) in Guatemala City, Guatemala. Interviews were conducted in the participants’ native language (English or Spanish), transcribed, and translated into English. Each transcript was coded by two researchers and analyzed for thematic content.ResultsEmotions around patient deterioration including concern, fear, and frustration were reported across all disciplines at both hospitals. Concern was often triggered by an elevated PEWS score and usually resulted in increased attention, which reassured bedside clinicians that patients were receiving necessary interventions. However, persistently elevated PEWS scores, particularly at St. Jude Children’s Research Hospital, occasionally resulted in a false sense of relief, diminishing clinician attention and negatively impacting patient care. Nurses at both institutions described how PEWS amplified their voices, engendering confidence and empowerment, two of the only positive emotions described in the study.ConclusionClinicians experienced a range of emotions while caring for high-risk patients in the setting of clinical deterioration. These emotions have the potential to contribute to compassion fatigue and burnout, or to resilience. Acknowledgment and further investigation of the complex interplay between PEWS and clinician emotions are necessary to maximize the impact of PEWS on patient safety while simultaneously supporting staff wellbeing.

A case of infective endocarditis due to Herbaspirillum Huttiense in a pediatric oncology patient

Infective endocarditis (IE) is an infection of the endocardium and/or heart valves that involves thrombus formation (vegetation). This condition might damage the endocardial tissue and/or valves. An indwelling central venous catheter is a major risk factor for bacteremia at-risked pediatric populations such as premature infants; children with cancer and/or connective tissue disorders. Herbaspirillum huttiense is a Gram-negative opportunistic bacillus that may cause bacteremia and pneumonia rarely in this fragile population. Herein we report the very first case of bacteremia and IE in a pediatric oncology patient caused by H. huttiense.

The Oncology Patient

The pediatric oncology patient is one of the most challenging patients for the pediatric anesthesiologist not only due to the multiplicity of potential comorbidities that can occur due to the oncologic process and chemotherapy but also due to the myriad of anesthetic exposures that the patient must endure. Because this population of children are the most anesthetized group of patients, it is imperative that the anesthesiologist work with a multidisciplinary team to minimize the number of exposures to anesthesia and thereby decrease the number of times that the child is without food and decrease the potential for complications. Given the recent Food and Drug Administration’s warning regarding the potential for neurotoxicity and number of exposures to anesthetics, it is also important to limit the number of anesthetics; this can be accomplished using a multidisciplinary approach and combining procedures as much as possible.

Development of Electronic Chemotherapy Roadmaps for Pediatric Oncology Patients

A chemotherapy roadmap is a summary of the chemotherapy plan for a pediatric oncology patient. Chemotherapy roadmaps exist as paper documents for most, if not all, pediatric oncology programs. Paper chemotherapy roadmaps are associated with risks that can negatively affect the safety of the chemotherapy process. This institution explored the feasibility of converting paper chemotherapy roadmaps into an electronic form. The pediatric information systems team developed an innovative computer application that can generate electronic chemotherapy roadmaps, and the pediatric oncology program established a novel workflow that can operationalize them. Electronic chemotherapy roadmaps have been produced for 36 treatment protocols, and 369 electronic chemotherapy roadmaps have been used for 352 pediatric oncology patients. They have functioned as designed and have not had any unintended effects. In the 5 years after their implementation, the average proportion of patient safety events involving paper or electronic chemotherapy roadmaps decreased by 78.7%. This report is the first to demonstrate the feasibility of creating and implementing electronic chemotherapy roadmaps. Continued expansion of the current library will be necessary to formally test the hypothesis that electronic chemotherapy roadmaps can decrease the risks associated with their paper counterparts and increase the safety of the chemotherapy process.