Pediatric Health Care Facilities Research Articles

Respiratory Syncytial Virus-Associated Hospitalizations in Children

The coronavirus disease 2019 pandemic disrupted respiratory syncytial virus (RSV) seasonality resulting in early, atypical RSV seasons in 2021 and 2022, with an intense 2022 peak overwhelming many pediatric healthcare facilities. We conducted prospective surveillance for acute respiratory illness during 2016-2022 at 7 pediatric hospitals. We interviewed parents, reviewed medical records, and tested respiratory specimens for RSV and other respiratory viruses. We estimated annual RSV-associated hospitalization rates in children aged <5 years and compared hospitalization rates and characteristics of RSV-positive hospitalized children over 4 prepandemic seasons (2016-2020) to those hospitalized in 2021 or 2022. There was no difference in median age or age distribution between prepandemic and 2021 seasons. Median age of children hospitalized with RSV was higher in 2022 (9.6 months vs 6.0 months, P < .001). RSV-associated hospitalization rates were higher in 2021 and 2022 than the prepandemic average across age groups. Comparing 2021 to 2022, RSV-associated hospitalization rates were similar among children <2 years of age; however, children aged 24 to 59 months had significantly higher rates of RSV-associated hospitalization in 2022 (rate ratio 1.68 [95% confidence interval 1.37-2.00]). More RSV-positive hospitalized children received supplemental oxygen and there were more respiratory virus codetections in 2022 than in prepandemic seasons (P < .001 and P = .003, respectively), but there was no difference in the proportion hypoxemic, mechanically ventilated, or admitted to intensive care. The atypical 2021 and 2022 RSV seasons resulted in higher hospitalization rates with similar disease severity to prepandemic seasons.

Transition of care of adolescents with rheumatic diseases in Saudi Arabia, current practice and obstacles

BackgroundThe importance of transition of care for adolescents with rheumatological illnesses from pediatric to adult rheumatology is increasing as the childhood rheumatologic diseases continue to adulthood. Despite that, transition practice in Saudi Arabia is not yet well-developed. ObjectivesThis study aims to evaluate the current transition of care practice for adolescents with rheumatological diseases to the adult healthcare facilities and the obstacles in achieving the best transition of care in Saudi Arabia. Setting and methodsThis is a non-interventional cross-sectional study conducted using an online survey that was distributed to pediatric and adult rheumatologists in Saudi Arabia. Google forms and Microsoft Excel 2016 were used for data entry and analysis. Descriptive statistics, frequencies and percentages were performed for categorical variables. ResultsA total number of 60 rheumatologists (27 pediatric and 33 adult) participated in the survey. Fifty-six (94%) of the participants do not follow any standardized programs for transition of care. All participants agreed on the need for a defined protocol for transition of care. The major barriers for successful transition of care were lack of protocols (63%), lack of healthcare providers (56%), and lack of well-developed systems that makes it difficult to access patient's electronic health records (55%). ConclusionA well-structured protocol for transition of care of adolescents with rheumatologic illnesses from pediatric to adult rheumatology in Saudi Arabia is still an unmet need. Efforts should be directed towards improving the practice of transition of care by establishing this protocol, enhancing the connectivity between pediatric and adult healthcare facilities, and encouraging pediatric and adult rheumatologists to adapt the transition of care protocol in their daily clinical practice.

Child Life Services for Siblings of Chronically Ill Children

Siblings of children with chronic illnesses are at high risk of adverse psychosocial and developmental outcomes, yet limited sibling-specific services are available at most pediatric healthcare facilities. Child life specialists are often the professionals most focused on and available to provide education, emotional support, and therapeutic play to support sibling coping needs in this context; however, little is known about the scope and availability of child life services for siblings of children with chronic illnesses. Therefore, the purpose of this survey-based study was to examine the type and frequency of child life services available to siblings in pediatric healthcare settings in North America, and to identify barriers to sibling support provision. Across the 76 participants in this study, a variety of sibling support frequencies and service types were identified, as well as barriers related to lack of clinical staffing, hospital-imposed visitation restrictions, and limited sibling support referrals from multidisciplinary team members. Noting these opportunities and limitations, it is crucial that healthcare administrators and institutions invest monetary and staffing resource to better meet the needs of siblings of hospitalized children.

A framework for the design of pediatric healthcare environment using the Delphi technique

By investigating specific therapeutic goals and design considerations, this paper aims to develop a framework for the design of a pediatric healthcare-built environment. Growing body of research indicates that the characteristics of pediatric healthcare facilities differ from those of adult healthcare facilities, therefore the findings of adult healthcare facility design cannot be generalized to pediatric healthcare facility design. Moreover, the studies specifically focusing on the built environment in pediatric healthcare are also sparse. Literature studies were conducted to extract therapeutic goals and design considerations. Two rounds of the Delphi technique were used to extract the Indian experts’ opinions, and to make a consensus among the experts on each goal and design considerations. SPPS software was used to calculate statistical output i.e., mean, standard deviation (SD), Interquartile range (IQR), coefficient of variation (CV), and boxplots. Results were drawn with the help of statistical data and boxplots. Finally, eight therapeutic goals and 33 design considerations emerged which may contribute towards designing pediatric healthcare environments. The design considerations will aid architects and facility planners in making design decisions for new or renovated pediatric healthcare facilities.

Case-mix adjustment of patient-reported experience measures in National Regional Center for Pediatric.

The aim of the study was to identify case-mix adjusters for the Chinese version of the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) and assess the impact of case-mix adjustment on patient experience measures in China. This study analyzed data collected from six National Regional Center for Pediatric across China retrospectively. Participants were children aged ≤17 years and their guardians who completed the survey. The Chinese Child-HCAHPS was used to measure pediatric inpatient care experience. Candidate case-mix adjusters were assessed using a summary measure of explanatory power. Changes in scores and rankings of the six centers were quantified to assess the impact of adjustment. A total of 2708 respondents completed the survey from January to March 2021, with a response rate of 7-15%. The child's global health status and the respondent being the child's mother were identified as case-mix adjusters, and case-mix adjustment models for 18 patient experience items were constructed. Kendall's τ correlation of hospital rankings before and after adjustment ranged from 0.73 to 1.00. Although the impact of case-mix adjustment may appear modest in our sample, it demonstrated the feasibility, necessity, and methodology for further development of case-mix adjustment models in pediatric healthcare facilities in China. Case-mix adjustment models adjust for factors that are unamendable by healthcare providers that may affect patient experience ratings, thereby improving the comparability of institutional-level ratings. Standardized case-mix adjustment protocols for quality measures need to be modified in different settings. This is the first study to identify adjustment variables and the possible impact of case-mix adjustment on pediatric inpatients' experience measures in a Chinese population. This study provided evidence on the feasibility and necessity for further development of case-mix adjustment models for pediatric healthcare facilities in China.

Impact of pending dental treatments on patient's oral health during COVID-19 pandemic in the United Arab Emirates

Background: Untreated dental problems can have a negative impact on the health and well-being of affected individuals, and delayed treatment would lead to serious oral problems. The outbreak of COVID-19 has shut down many dental care services, and this has deferred dental treatment for many. Assessing the effect of pending dental treatment will clarify the role and importance of dental services in maintaining and controlling oral health. Aims and Objectives: This study was carried out to explore the impact of COVID-19 on pending dental treatment among United Arab Emirates (UAE) residents. Assessing the importance of dental services, studying patients' self-management of symptoms, comparing the most affected categories, and determining the demand of developing a forward strategy in case of a future pandemic. Methodology: A cross-sectional study was designed using a pre-tested questionnaire published in an online survey among UAE residents that included participants from all seven emirates. Consent was conducted from each participant after ensuring anonymity and confidentiality. The collected responses were tabulated and subjected to statistical analysis. Appropriate tests of significance were used, and a P< 0.05 was considered statistically significant. Results: The analysis showed about 34.2% of the participants had pending dental treatment due to COVID-19. The most deferred treatment was orthodontic treatment by 18.6% of participants. The commonly affected oral region was the teeth, where toothache was the most reported oral symptom. Conclusion: The findings showed that the pandemic had a significant impact on the dental health of UAE residents due to postponed treatment. It is suggested to raise the level of awareness and the shifting of the dental care paradigm to preventive strategies has to be developed according to the new guidelines focusing on reducing the risk factors of oral cancer. The new strategies emphasise dental health promotion, topical fluorides and nutritious diet. Oral health messaging and actions should be incorporated in pediatric offices and primary health-care facilities. Moreover, allocate mandatory periodic dental checkups for compromised patients. Dentists should consider alternative strategies to address these deferred treatments during such pandemics.

Parent Satisfaction With Pediatric Speech-Language Pathology Telepractice Services During the COVID-19 Pandemic: An Early Look

Purpose: The aim of this study was to evaluate parent/guardian satisfaction with speech-language pathology telepractice services provided at a New York–based pediatric health care facility during the COVID-19 pandemic. Specifically, satisfaction with appointment maintenance, progress, acquisition of goals, and parent education was measured. Method: Researchers identified patients from 0 to 21 years of age who received at least one speech-language pathology telepractice service from May 1 to May 29, 2020, for study inclusion. One hundred seven patients met the inclusion criteria. A qualitative survey with four Likert scale questions was e-mailed to a parent/guardian of these patients. Questions assessed interest in maintaining telepractice services following the COVID-19 pandemic in addition to rating satisfaction with appointment maintenance, parent/caregiver education, and patient progress. Thirty participants completed the survey, reflecting 28% completion rate. Results: Parents/guardians indicated overall satisfaction with pediatric speech-language pathology telepractice services. Qualitative analyses revealed subthemes for advantages and disadvantages of the telepractice platform. Advantages included convenient scheduling and session maintenance, improved safety in the setting of COVID-19, opportunities for visual models that were not possible while masked, and increased opportunities for parent education and training in the child's natural environment. High-level clinician engagement, continuity of care, creativity, and a well-established clinical rapport improved the efficacy of telepractice sessions. Reported disadvantages included distractibility, patient age contingencies, technological difficulties, restricted treatment modalities, and virtual session structure. Results implied a preference for in-person speech-language pathology sessions versus telepractice at this facility. Conclusions: The results of this survey study indicated parent satisfaction with speech-language pathology services via telepractice. Patients' return to in-person speech-language pathology sessions when available in subsequent months does imply a preference for in-person care. However, the notable advantages and disadvantages of telepractice expressed by parents/guardians at the researchers' facility during the early months of the COVID-19 pandemic offer valuable insights for current and future speech-language pathology telepractice providers.

Positively waiting: Technology as the preferred distractor in a pediatric outpatient setting

Visiting any pediatric outpatient clinic as a child may be considered a stressful and anxiety-inducing experience. The literature suggests that positive distractions, such as pet therapy and single-user electronic devices, may aid in reducing anxiety and maximizing patient satisfaction throughout the patient’s experience at a pediatric outpatient clinic. The aim of this pilot quality improvement project was to determine which positive distractions patients experienced and whether single-user electronic loaner devices should be provided to patients at pediatric outpatient facilities. A quantitative causal comparative approach was utilized in identifying patient exposure to key positive distraction techniques that may significantly decrease anxiety. The independent variable was the patient gender as reported by the caretaker. The term “caretaker” refers to the adult parent, guardian, relative, or friend accompanying the patient. The dependent variables were caretakers’ responses to interview questions regarding exposure to and interest in various positive distractors. Most patients reported more interactions with therapy dogs than either clowns or musicians, with none reporting magician interaction while waiting for their appointments. Many patients (71%) demonstrated interest in having access to single-user electronics during clinic appointment wait times. Male patients showed great interest (87%) in having access to single-user electronics. Findings suggest that pediatric healthcare facilities funding single-user electronics to reduce patient anxiety may increase patient satisfaction. Additionally, data suggest administrators may benefit by offering an array of positive distractions, with a particular focus on pet therapy programs. Child life specialists are particularly suited for overseeing the implementation of an efficient and effective program.

Prevalence of Acute Otitis Media in Febrile Children at a Tertiary Care Hospital

Objective: To find out the prevalence of acute otitis media among febrile children presenting at a tertiary healthcare facility. Study Design: A cross-sectional study. Place and Duration of the Study: The Department of Pediatrics, Chandka Medical College, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana from 1st January 2021 to 30th June 2021. Material and Methods: A total of 118 children of both genders aged 2 to 11 years with fever (temp&gt;100.4 0F) for a minimum duration of 6 hours were included. Demographic data along with presenting symptoms were noted. Auroscopy/otoscopy was performed in all cases for the diagnosis of AOM. All the study data was entered into SPSS version 26.0 for statistical analysis. Results: In a total of 118 children, 67 (56.8%) were male. Mean age was noted to be 4.9±4.2 years (ranging between 2 to 12 years) and 62 (52.5%) children were aged between 2 to 5 years. Mean duration of fever was 6.20±1.7 days (ranging between 3 to 9 days) while 75 (63.6%) children had duration of fever above 5 days. Mean maximum reported fever was 103.04±1.1 0F. Irritability, dizziness, restlessness and diminished appetite were the most frequent symptoms noted in 98 (83.1%), 67 (56.8%), 61 (51.7%), and 58 (49.2%) patients respectively. The prevalence of AOM was observed in 27 (22.9%) febrile children. Conclusion: The prevalence of acute otitis media among febrile children was high. High index of suspicion for acute otitis media should be made whenever febrile children are presenting to pediatric healthcare facilities. Keywords: Acute otitis media, febrile, irritability, dizziness.

Operational Effect of COVID-19 on Surgical Care at a Tertiary Pediatric Hospital.

ABSTRACTThe detrimental effects of the coronavirus disease 2019 (COVID‐19) pandemic have profoundly disrupted surgical care at health care facilities worldwide. At our tertiary pediatric hospital, we made substantial adjustments to surgical suite utilization and staff member scheduling to account for reductions in surgical volume, increased demand for staff members in other sectors of the hospital, and the highly infectious properties of the virus. Perioperative leaders took advantage of the pandemic’s disruption to clinical activities to design and implement a new procedure‐scheduling process to rectify the inefficiencies that had accumulated as the previous system evolved. The implementation of said directives was largely facilitated by establishing communication with all involved parties for their input and feedback throughout the process. Although COVID‐19 has had varying effects on procedural operations across pediatric health care facilities, we believe our institutional response to the disruptive forces of COVID‐19 is of benefit to pediatric hospitals worldwide.

Prevalence of SARS-CoV-2 antibodies in pediatric healthcare workers

ObjectivesTo determine SARS-CoV-2-antibody prevalence in pediatric healthcare workers (pHCWs). DesignBaseline prevalence of anti-SARS-CoV-2-IgG was assessed in a prospective cohort study from a large pediatric healthcare facility. Prior SARS-CoV-2 testing history, potential risk factors and anxiety level about COVID-19 were determined. Prevalence difference between emergency department (ED)-based and non-ED-pHCWs was modeled controlling for those covariates. Chi-square test-for-trend was used to examine prevalence by month of enrollment. ResultsMost of 642 pHCWs enrolled were 31-40years, female and had no comorbidities. Half had children in their home, 49% had traveled, 42% reported an illness since January, 31% had a known COVID-19 exposure, and 8% had SARS-CoV-2 PCR testing. High COVID-19 pandemic anxiety was reported by 71%. Anti-SARS-CoV-2-IgG prevalence was 4.1%; 8.4% among ED versus 2.0% among non-ED pHCWs (p < 0.001). ED-work location and known COVID-19 exposure were independent risk factors. 31% of antibody-positive pHCWs reported no symptoms. Prevalence significantly (p < 0.001) increased from 3.0% in April–June to 12.7% in July–August. ConclusionsAnti-SARS-CoV-2-IgG prevalence was low in pHCWs but increased rapidly over time. Both working in the ED and exposure to a COVID-19-positive contact were associated with antibody-seropositivity. Ongoing universal PPE utilization is essential. These data may guide vaccination policies to protect front-line workers.

Impact of COVID-19 on Cleft Surgical Care

Background: Coronavirus disease 2019 (COVID-19) has greatly impacted pediatric healthcare facilities throughout the United States due to widespread case rescheduling and the implementation of supplementary COVID-19 perioperative protocols. To our knowledge, no studies have investigated the impact of COVID-19 on case volume, surgical timing, or operational aspects of cleft surgical procedures. The aim of this study is to investigate the impact that COVID-19 has had on cleft surgical care at our institution. Methods: A retrospective study comparing cleft surgical care in 2019 (the pre-pandemic cohort) and 2020 (the COVID-19 cohort) was designed. All patients who underwent a cleft surgical procedure from April 1st to August 31st in 2019 and 2020 were included for analysis. Procedures were stratified into 4 groups: primary cleft lip repairs, primary cleft palate repairs, alveolar bone grafting procedures, and revisional/secondary repair procedures. Variables investigated in this study included: surgical volume, number of patients receiving timely surgery, causes for untimely surgery, number of combined cases, number of delayed cases, delay time, time under anesthesia, and procedure length. Results: A total of 191 cleft surgeries, 102 in 2019 and 89 in 2020, were identified during the study period. We observed no statistically significant differences in cleft surgical volume and other investigated variables across all surgical subgroups from 2019 to 2020. Conclusion: Cleft surgical care was largely unaffected by COVID-19 despite high rates of case rescheduling and the addition of supplementary perioperative safety protocols. More studies are needed to assess the impact of COVID-19 on cleft surgical care at other cleft centers and to investigate the long-term outcomes of these patients.

Evaluation of Novel “No-Touch” Technologies for Decontamination of Toys in Pediatric Healthcare Settings

Background: Toys in playrooms are often shared among patients in pediatric healthcare settings; they can present a risk for transmission of bacterial and viral pathogens. Effective cleaning and disinfection of toys using disinfectant wipes is labor intensive and difficult due to irregular surfaces. Methods: We conducted a point-prevalence culture survey to determine the frequency of contamination of in-use toys and high-touch surfaces in playrooms in a pediatric healthcare facility with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridioides difficile. Using a variety of toys inoculated with pathogens, we evaluated efficacy and ease-of-use of 3 novel “no-touch” technologies: (1) an electrostatic sprayer, (2) a small ultraviolet-C (UV-C) box (18.9 × 9.9 × 1.8 inches) for smaller toys, and (3) a high-level disinfection cabinet using ultrasonic submicron droplets of peracetic acid and hydrogen peroxide. Test pathogens included C. difficile, MRSA, and Candida auris. Results: Of 135 items cultured in playrooms, 6 (4.4%) were contaminated with MRSA, 1 (0.7%) was contaminated with VRE, and none were contaminated with C. difficile. Each of the technologies reduced all pathogens by &gt;4 log10 CFU on all types of toys tested (plastic, soft rubber, and tablet). The electrostatic sprayer was considered the easiest to use by all users because large numbers of toys could be processed much more quickly (ie, spray for 20 seconds and allow to air dry) than with disinfectant wipes. The disinfection cabinet required 21 minutes for cycle completion, whereas the decontamination cycle for the UV box was only 30–90 seconds but with limited capacity to hold toys. Conclusions: Three “no-touch” technologies were effective for disinfection of toys contaminated with healthcare-associated pathogens. The electrostatic spray application of disinfectant was considered the easiest to use for rapid decontamination of toys.Funding: NoneDisclosures: None

Prevalence of Cholesteatoma in Children With Down Syndrome Receiving Treatment at Pediatric Health Care Facilities

Prevalence of Cholesteatoma in Children With Down Syndrome Receiving Treatment at Pediatric Health Care Facilities

Fatigue in Children With Moderate or Severe Traumatic Brain Injury Compared With Children With Orthopedic Injury: Characteristics and Associated Factors

To characterize fatigue in children with moderate or severe traumatic brain injury (TBI) and to identify associated factors. Urban tertiary pediatric healthcare facility. Children aged 5 to 15 years with a moderate TBI (n = 21), severe TBI (n = 23), or an orthopedic injury (OI; n = 38). Case-control study. (i) Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS), completed by parents and children; (ii) Sleep Disturbance Scale for Children, completed by parents. Data on injury-specific factors and other factors of interest were also collected. The 2 TBI groups did not differ on any of the fatigue outcomes (child or parent ratings). Relative to the OI group, parents rated children in both TBI groups as experiencing greater fatigue. However, on self-ratings, only children with moderate TBI endorsed greater fatigue. Sleep was commonly associated with fatigue, with child sleep disturbance and child sleep hygiene associated with parent-rated and self-rated child fatigue, respectively. Individually, there were no cases of "normal" fatigue coinciding with severe sleep disturbance. However, there were several cases of severe fatigue coinciding with normal sleep. Additional factors associated with fatigue were older age at injury, longer time since injury, and/or greater internalizing difficulties. Children with moderate and severe TBI experience greater fatigue than OI controls. Parent and child ratings of fatigue appear to be associated with different factors, indicating that fatigue management may require a broad range of treatments.

A Guide to Chatbots for COVID-19 Screening at Pediatric Health Care Facilities.

The coronavirus disease 2019 (COVID-19) outbreak has required institutions to rapidly adapt to changing public health circumstances. The Centers for Disease Control and Prevention has encouraged health care facilities to explore novel health care delivery modes. However, many institutions may not be prepared to begin offering digital health and telehealth services. Chatbots are one digital health tool that can help evolve triage and screening processes in a scalable manner. Here, we present a decision-making and implementation framework for deploying COVID-19 screening chatbots at pediatric health care facilities.

AB030. Creating a workplan for emergency evacuation of a pediatric healthcare facility

AB030. Creating a workplan for emergency evacuation of a pediatric healthcare facility

Early Season Pediatric Influenza B/Victoria Virus Infections Associated with a Recently Emerged Virus Subclade - Louisiana, 2019.

Multiple genetically distinct influenza B/Victoria lineage viruses have cocirculated in the United States recently, circulating sporadically during the 2018-19 season and more frequently early during the 2019-20 season (1). The beginning of the 2019-20 influenza season in Louisiana was unusually early and intense, with infections primarily caused by influenza B/Victoria lineage viruses. One large pediatric health care facility in New Orleans (facility A) reported 1,268 laboratory-confirmed influenza B virus infections, including 23 hospitalizations from July 31 to November 21, 2019, a time when influenza activity is typically low. During this period, Louisiana also reported one pediatric death associated with influenza B virus infection. An investigation of the influenza B virus infections in Louisiana, including medical and vaccine record abstraction on 198 patients, primarily from facility A, with sporadic cases from other facilities in the state, found that none of the patients had received 2019-20 seasonal influenza vaccine, in part because influenza activity began before influenza vaccination typically occurs. Among 83 influenza B viruses sequenced from 198 patients in Louisiana, 81 (98%) belonged to the recently emerged B/Victoria V1A.3 genetic subclade. Nationally, to date, B/Victoria viruses are the most commonly reported influenza viruses among persons aged <25 years (2). Of the 198 patients in the investigation, 95% were aged <18 years. Although most illnesses were uncomplicated, the number of hospitalizations, clinical complications, and the reported pediatric death in Louisiana serve as a reminder that, even though influenza B viruses are less common than influenza A viruses in most seasons, influenza B virus infection can be severe in children. All persons aged ≥6 months should receive an annual influenza vaccination if they have not already received it (3). Antiviral treatment of influenza is recommended as soon as possible for all hospitalized patients and for outpatients at high risk for influenza complications (including children aged <2 years and persons with underlying medical conditions) (4).

Russian therapeutic school: Dmitriy D. Pletnev, Aleksandr L. Myasnikov, Evgeniy I.Chazov

This article is devoted to a remarkable data, the 90th anniversary of Academician of Russian Academy of Science, Hero of Socialist Labour of the Soviet Union, Evgeniy I. Chazov. His multifaceted personality has been formed under an influence of Dmitriy D.Pletnev, who founded of a Russian therapeutic school at the middle of 20th, the 20th century. Evgeniy I. Chazov is known not only as a scientist and a physician, but also as a talented public health manager. He was at the head of Healthcare Ministry of Soviet Union from 1987 to 1990. Under his leadership and with his direct participation, the Soviet healthcare system acquired novel modern features: a network of diagnostic centers and pediatric healthcare facilities was organized that led to decrease in child mortality, healthcare provision in extreme conditions, development of control measures against human immunodeficiency virus, and updating the legislation on psychiatric care. Novel business principles were implemented in the country by Evgeniy I. Chazov; high tech diagnostic equipment was supplied to medical institutions.

534. Clostridium difficile Reduction: An Agent-Based Simulation Modeling Approach to Evaluating Intervention Comparative Effectiveness at Pediatric Hospitals

Background Clostridium difficile surveillance data are lacking from pediatric facilities and there are few pediatric-centered guidelines or studies evaluating C. difficile targeted pediatric interventions. Compared with the adult setting, C. difficile control in pediatric healthcare facilities is also further complicated by epidemiologic variability across the age spectrum and increased patient-to-patient and patient-to-family interactions.MethodsWe constructed an agent-based simulation model of C. difficile transmission at a freestanding children’s hospital. The 80-bed hospital model included interactions between the physical environment, patients, visitors, family caregivers, nurses, and physicians. The model was then used to evaluate the comparative effectiveness of nine infection control interventions and six multiple-intervention bundles at reducing hospital-onset C. difficile infections and asymptomatic C. difficile colonization.ResultsThe most effective two-intervention bundle, composed of daily cleaning with sporicidal disinfectant and an asymptomatic C. difficile screening protocol, reduced hospital-onset C. difficile infection by 62.0% and asymptomatic colonization by 88.4%. Six of the nine single-intervention strategies also significantly reduced both outcomes, including daily and terminal cleaning, asymptomatic C. difficile screening, healthcare worker and patient hand hygiene, and reducing room transfers. The remaining three single-intervention strategies, visitor hand hygiene and visitor and healthcare worker contact precautions, did not significantly reduce either measure.ConclusionThis is the first mathematical model to evaluate pediatric C. difficile transmission. Hospitals can achieve a high rate of reduction for hospital-onset C. difficile infections by prioritizing implementation of a small number of interventions with high fidelity.Disclosures All authors: No reported disclosures.