Improving Patient and Employee Safety through Implementation of an Infection Risk Screening Process for International Patients at Boston Children’s Hospital—The “AIRSHIP” Protocol

Abstract

Background Vaccine-preventable diseases and multi-drug-resistant organisms (MDROs) are common outside of the US, and multiple infectious outbreaks have been linked to travelers. Boston Children’s Hospital cared for 2796 international patients in 2016 but lacked an infection risk screening process for these patients, placing patients and staff at risk. We developed the Assessing Infection Risks for Safe Healthcare of International Patients (AIRSHIP) protocol to identify risks to guide infection prevention and control (IPC) measures.Methods A multidisciplinary team of IPC, infectious diseases, and International Health Services (IHS) experts assessed current IHS intake procedures and stakeholder engagement. We then developed AIRSHIP, devising standardized processes and forms to (1) assess underimmunization, MDRO and tuberculosis history, recent exposures, and current symptoms and (2) triage cases for catch-up immunization, urgent healthcare evaluation, and/or IPC intervention (Figure 1). We piloted incorporation of AIRSHIP into existing intake procedures. We tracked process, outcome, and balancing measures to evaluate feasibility, effectiveness, and acceptability to families (Figure 2) and made iterative improvements through Plan-Do-Study-Act (PDSA) cycles.ResultsFor our first 13 cases, we completed pre-arrival family and referring provider interviews in 5 cases and on-arrival family interviews in 8 cases (in no cases were both pre-arrival and on-arrival interviews feasible). We were able to assign a risk category in all cases, identifying 5 patients with infection risks (38%) and 4 who were undervaccinated (30%). In 7 of 8 cases (88%) in which on-arrival interviews were performed, the interview and referring provider records yielded complete and reliable data. The average duration of family interviews was 18 minutes. All 13 families reported being “very satisfied” with AIRSHIP.Conclusion International patients often present with active infections and are commonly undervaccinated. A feasible and effective strategy for infection risk screening of international patients is review of records pre-arrival, together with on-arrival family interview to gather additional data and identify acute symptoms and exposures.Disclosures All authors: No reported disclosures.