June 22, 2020

Interim Physician-in-Chief Dr. James Versalovic and several other Texas Children’s physicians recently published a paper in the Oxford Academic: The Journal of the Pediatric Diseases Society detailing the clinical course of 57 children with COVID-19 cared for at Texas Children’s at the beginning of the pandemic. Dr. Catherine Foster with Infection Control and Prevention is the lead author of the paper and Dr. Judith Campbell with Infection Control and Prevention is the senior author.

The paper’s overall findings were that most of the children were mildly symptomatic, and only a few patients with underlying medical conditions required hospitalization. System wide, the patient evaluation processes at Texas Children’s allowed for prompt identification and management of patients with COVID-19.

“These outcomes are an affirmation that we were doing what we need to do to provide the best care for patients and their families,” said Campbell, medical director of Infection Control and Prevention. “They tell us that we are identifying patients early and getting them the help they need quickly all while helping to reduce the spread of COVID-19.”

Some key findings of the study, which took place during the first five weeks of the outbreak in Houston include:

Identification process

  • Pre-procedural surveillance testing identified three patients who had no respiratory symptoms
  • The majority (71 percent) of cases presented in the ambulatory setting

Patient demographics

  • Fifty-six percent of all 57 patients were male
  • Median age was 10.7 years (range was 0.1 – 20.2 years)
  • Asthma (12 percent) was the most common underlying condition, followed by sickle cell disease (7 percent)
  • More than half of the cases (54 percent) reported a laboratory-confirmed COVID-19 household contact
  • International travel was reported in two cases (Mexico and Commonwealth of Dominica) and interstate travel in one case (New Jersey)
  • Most patients (83 percent) presented with either fever or cough, including all of the patients who presented to the Emergency Center
  • Fever was reported in 53 percent of ambulatory patients, 90 percent of EC patients, and 25 percent of hospitalized patients

Patient care

  • Six patients were cohorted in the Special Isolation Unit at Texas Children’s Hospital West Campus
  • Half of the hospitalized patients required supplemental oxygen via nasal cannula, and 1 patient was on home bilevel positive airway pressure without supplemental oxygen.
  • No patients required mechanical ventilation
  • The median length of stay was 2 days (range, 1 – 10 days)
  • None of the 57 patients received therapeutic agents to treat COVID-19
  • No patients died

In addition to the data above, the paper evaluated Texas Children’s Hospital’s integrated system approach to the evaluation and management of patients during the COVID-19 pandemic by performing a retrospective assessment of all pediatric patients with COVID-19 cared for through the Texas Children’s system.

COVID-19 was declared a pandemic by the World Health Organization on March 11. As of the beginning of June, the Centers for Disease Control and Prevention reported more than 1.8 million COVID-19 cases and 100,000 plus deaths in the United States. Early reports have provided critical insights on the clinical manifestations of the disease in children. Most children appear to have asymptomatic or mild to moderate respiratory illness, whereas adults, especially the elderly, are more likely to suffer severe respiratory illness and a higher case fatality rate. Given the rapidly evolving nature of the COVID-19 pandemic, data on the epidemiology and clinical course of pediatric patients with COVID-19 in the United States are lacking.

“That’s why it’s so important to document what we are seeing and doing and share these findings with the medical community worldwide,” Versalovic said. “Texas Children’s has been doing this since the onset of the pandemic and will continue to be on the leading edge of scholarship and care of pediatric COVID-19 patients.”

Paper authors include:
Dr. Catherine Foster, Infection Control and Prevention
Dr. Elizabeth Moulton, Infection Control and Prevention
Dr. Flor Munoz, Infection Control and Prevention
Dr. Kristina Hulten, Infection Control and Prevention
Dr. James Versalovic, Interim Physician-in-Chief
Dr. James Dunn, Pathology
Dr. Paula Revell, Pathology
Dr. Tjin Koy, Infection Control and Prevention
Dr. Amy Arrington, Special Isolation Unit
Dr. Lucila Marquez, Infection Control and Prevention
Dr. Judith Campbell, Infection Control and Prevention

March 21, 2017

Imagine spending several months trying to find the pathogen responsible for a cluster of Burkholderia cepacia infections among critically ill, hospitalized patients. For infection preventionists, solving this mystery can be a daunting task but not impossible if you have the epidemiology skills and collaborative resources in your investigative toolbox.

When Texas Children’s had a small outbreak of B. cepacia infection last year, Texas Children’s Quality and Safety Director Elaine Whaley immediately sprang into action to identify the cause of the outbreak. Her extensive experience in infection prevention and control coupled with her professional networking skills helped her locate an infection preventionist at another pediatric hospital one-thousand miles away who had experienced a similar outbreak. Together, they identified the pathogen responsible for the B. cepacia outbreak in their respective hospitals.

Partnering with Infection Preventionist Angela Rupp of Lurie Children’s Hospital of Chicago, their collaborative investigation expedited the nationwide recall of liquid docusate, a medication used to treat constipation. This product was later found to be contaminated with the bacterium B. cepacia, which was directly responsible for the sudden outbreak of infection at both hospitals.

As a result of their work and commitment to promoting a culture of safe patient care, Whaley and Rupp will be recognized with the Heroes of Infection Prevention Award during a special ceremony in Portland by the Association for Professionals in Infection Control and Epidemiology (APIC).

“It is a great honor to have one of our own be nationally recognized for this heroic award in patient safety,” said Trudy Leidich, Texas Children’s assistant vice president of Quality and Safety. “We are grateful to Elaine and our Infection Control team for identifying the direct source of contamination in order to keep our patients safe and free from preventable harm.”

B. cepacia is the name for a group of bacteria that can be found in soil and water and are often resistant to antibiotics. The bacterium can cause life-threatening infection in high-risk, medically complex children, such as children with cystic fibrosis and immunocompromising conditions.

In February 2016, when a small cluster of patients at Texas Children’s and Lurie Children’s Hospital came down with B. cepacia infection, Whaley and Rupp initiated separate outbreak investigations. But once the two hospitals’ clusters were confirmed to be identical, the patients were combined to facilitate the investigation.

After thorough analyses, their investigation found that the ducosate product at each hospital came from the same manufacturer. After reporting these findings to the Centers for Disease Control, the Food and Drug Administration was called into the investigation which subsequently resulted in a national product recall. This recall protected patients at Texas Children’s and patients at other pediatric hospitals across the nation from this serious pathogen.

September 7, 2016

9716sskatiejones175Katie Jones of Infection Control is the latest Texas Children’s Super Star employee. “Working at Texas Children’s has afforded me the opportunity to grow as an educator and presenter, so that I can share my passion for infection control with health care providers and encourage them to be infection prevention advocates in their own areas,” Jones said. Read more of her interview below and find out how you can nominate a Super Star.

Your name, title and department. How long have you worked here?
Katie Jones, Infection Control Coordinator, Infection Control. I started working for Texas Children’s in July 2015.

What month are you Super Star for?
September 2016

Tell us how you found out you won a super star award.
I thought I was attending a regularly scheduled staff meeting, and at the last minute we changed rooms. When I arrived, I saw that leaders from quality and critical care nursing were at the table. They do not normally attend our regular weekly staff meetings. My manager said he had an announcement, it all felt very serious with our additional guests in attendance so I was a little worried at first – but then he announced that I had received the Super Star award! It was very surprising and flattering! It was so much fun to share that moment with my department and enjoy cake and punch with them.

What does it mean to be recognized for the hard work you do? How has the organization helped you achieve your personal and professional goals?
Everyone I encounter at Texas Children’s gives 110 percent of themselves every day, so it is really an honor to be selected. Working at Texas Children’s has afforded me the opportunity to grow as an educator and presenter, so that I can share my passion for infection control with health care providers and encourage them to be infection prevention advocates in their own areas.

What do you think makes someone at Texas Children’s a super star?
Coming to work every day ready to say “yes” to any challenge.

What is your motivation for going above and beyond every day at work?
I believe there is a patient advocacy element to everyone’s job in a health care environment – even if you don’t provide direct patient care. I love that by working in Infection Control, I have an opportunity to play a role in the development and implementation of initiatives that can protect our patients and help Texas Children’s continue to be a leader in patient care, research, and education.

What is the best thing about working at Texas Children’s?
I am inspired every day by the passion exhibited by our frontline health care workers and my fellow infection control team members. We are all very supportive of each other and one person’s success is a victory for the whole team.

What does it mean to you that everyone at Texas Children’s is considered a leader? What is your leadership definition?
Leaders identify themselves by their actions, not their job title. By encouraging everyone to put our patients and their families first, the behavior that makes someone a leader in their own role is naturally supported.

Anything else you want to share?
I want to thank the Shannon Holland and the PICU team for nominating me for this award. It is truly a privilege to work with them.

May 5, 2015

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Texas Children’s is proud to announce that Dr. Judith Campbell was recently named medical director of the Infection Prevention and Control Department. The department is focused on improving the overall quality of health care by preventing and/or controlling disease transmission through the use of sound epidemiologic principles and scientific-based decision making.

In her new role, Campbell will serve as a physician partner to Elaine Whaley, who is the director of the Infection Prevention and Control Department. Campbell also will serve as a physician partner to several infection control practitioners as they ensure compliance with infection control policies and procedures, and make decisions regarding the implementation and institution of surveillance, isolation, and outbreak investigation.

With this added responsibility, Campbell said she will reduce her number of clinical service months from six to four.

“I am honored and humbled to be asked to serve in this capacity at Texas Children’s Hospital,” Campbell said about her new appointment. “I appreciate the years of training and mentoring I have received from my predecessors in this role and look forward to addressing the challenges and opportunities for improvement at Texas Children’s Hospital through collaboration, scholarship and hard work.”

In addition to her new appointment with the Infection Prevention and Control Department, Campbell is one of the attending physicians for the Infectious Disease Service. She also is the program director for the Pediatric Infectious Disease Fellowship program is an associate medical director of our new eight-bed special isolation unit at Texas Children’s Hospital West Campus. This unit will be designed for children with highly contagious infectious diseases.

After earning her medical degree from Baylor College of Medicine, Campbell completed an internship, residency, chief residency and infectious disease fellowship at Texas Children’s Hospital. She was pleased to be offered an opportunity to serve on the faculty upon completion of her clinical and research training in 1992. Since then, she has been focused on the medical education of residents and fellows, and on providing care for infants, children and adolescents with a variety of infectious diseases. She has a special interest in hospital epidemiology/infection prevention and innovative programs and strategies for medical education.

December 9, 2014

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Texas Children’s announced on December 4 our plan to build an eight-bed special isolation unit at Texas Children’s Hospital West Campus. This unit will be designed for children with highly contagious infectious diseases, such as pandemic influenza, enterovirus D68, Ebola, and many others. Additionally, we announced the state’s designation of our organization as a pediatric Ebola treatment center.

About the isolation unit

This new isolation unit at Texas Children’s will be similar to the four other biocontainment units in the country. Such units are equipped and staffed to care for patients with contagious infectious diseases.

“We will build a state-of-the-art isolation unit designed and staffed to provide the highest quality care and treatment for infants and children with serious or life-threatening infectious diseases of public health significance, always with the greatest possible margin of safety,” said Texas Children’s Physician-in-Chief Dr. Mark W. Kline. “We believe this will be an indispensable resource to our local community, Texas and the nation.”

This new unit will incorporate all of the latest scientific and technological approaches to biocontainment, including negative air pressure, laminar air flow, high-efficiency particulate air (HEPA) filtration, separate ventilation, anterooms, biosafety cabinets, a point-of-care laboratory, special security access, autoclaves and incinerators. There will be two levels of protection from airborne particles, as well as a comprehensive waste management plan, among other safety features.

It will be fully equipped to care for any infant or child with a serious communicable disease, with all of the measures available to assure safety of the health care team, other patients and their families. A point-of-care biosafety level 3 laboratory will enable the care team to monitor the progress of patients and perform rapid detection methods to identify unusual pathogens. Housed at Texas Children’s Hospital West Campus, the unit is anticipated to have capacity for eight patients, all in private rooms.

This specialized unit will be led by Dr. Gordon Schutze, who will serve as medical director, as well as Dr. Judith Campbell and Dr. Amy Arrington, who will be the unit’s associate medical directors. It will be staffed by an elite team of experienced critical care and infectious disease nurses and physicians, all of whom will have successfully completed an intensive advanced certification course and practicum in infection control, hospital epidemiology and management of infectious diseases in the critical care setting. The staff will maintain their certification through participation in ongoing educational activities.

Kline said Texas Children’s is working with the Centers for Disease Control and Prevention to design, build, equip and staff the unit, which is expected to be operational within nine months and cost approximately $16 million to build.

“I could not be more impressed with Texas Children’s desire to run towards issues of critical importance to the health and well-being of the children of Texas and our nation,” said Dr. Brett Giroir, director of the Texas Task Force on Infectious Disease Preparedness and Response and chief executive officer of the Texas A&M Health Science Center.

Caring for potential Ebola patients

Since the summer, Texas Children’s has been implementing a detailed plan to identify, isolate and treat suspected cases of Ebola, if necessary. As a result, following a visit from the CDC, the State of Texas designated Texas Children’s as a pediatric Ebola treatment center.

As part of the hospital’s preparation, specific protocols were developed outlining steps staff would take if and when a patient with Ebola symptoms arrived at a Texas Children’s facility. Additionally, in order to decrease the risk of exposure and provide the complex care required, the hospital identified specific areas and units responsible for caring for any patient with Ebola. The health care workers in those areas have received intense, ongoing training and simulation to help them prepare.

“This unit is part of the hospital’s long-term vision to care for children with the most serious and complex medical conditions,” said Michelle Riley-Brown, president of Texas Children’s Hospital West Campus. “Our leadership’s decision to build this new isolation unit at West Campus speaks volumes about our staff and employees’ skill, expertise and experience here. Our agility and responsiveness were tested just a few months ago when we had a patient with suspected Ebola under investigation. Our handling of that case demonstrated our competency here at West Campus, and it boosted the entire organization’s confidence in the readiness across the system.”

West Campus staff and employess helped lead the way for the organization to refine our protocols for care, and now Texas Children’s will lead the way for centers across the country. If you have questions about the unit or an interest in being trained to be part of the care team that will staff this unit, please contact your leader for more information.

Return to Ebola Response site.

September 24, 2014

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News of Enterovirus D68 (EV-D68) cases have increased in the media in recent weeks, just of many of us are bracing for the onset of cold and flu season. Texas Children’s leaders encourage staff and employees to arm themselves with the facts about EV-D68.

The issue isn’t the actual virus, rather it’s the severity of the person’s illness who may have it. Patients with underlying pulmonary disease are at increased risk of significant illness from EV-D68, said Dr. Jeffery Starke, Texas Children’s director of Infection Control. However, most children infected with the virus only have mild illness that is indistinguishable from other respiratory infections.

“It is not necessary to take children to the emergency room or rush to the pediatrician’s office,” Starke said. “Only children with significant symptoms need to seek care.”

Significant symptoms include intense wheezing, difficulty breathing or uncontrollable coughing.

Here are the other things you need to know about the rare respiratory illness that has cropped up this year in several states across the country:

What is the current situation?
For the first time since 2012, the Centers for Disease Control and Prevention has confirmed several cases of EV-D68. So far this year, 160 people in 22 states have tested positive for the virus. No deaths attributed to the infection have been documented.

What is EV-D68?
EV-D68 is a rare form of enterovirus that affects the respiratory system. First identified in California in 1962, EV-D68 was rarely seen until 2009, when there were outbreaks in Japan, the Philippines and the Netherlands. Small clusters of cases were identified in the United States around the same time.

Who is at risk?
Infants, children and teenagers are most likely to get infected and become ill since they don’t have an immunity from previous exposures to enteroviruses. The most severe cases tend to involve children with asthma and other preexisting respiratory problems.

What are the symptoms?
Symptoms of EV-D68 are usually mild, barely distinguishable from a common cold. However, a small percentage of children develop intense wheezing, difficulty breathing or uncontrollable coughing.

Are there any treatments?
There is no vaccine to prevent EV-D68 and no drug to attack it. Parents can treat the pain and achiness with over-the-counter medications, and for more serious cases doctors have used albuterol and supplemental oxygen.

How is EV-D68 transmitted?
Like most other respiratory viruses, EV-D68 is transmitted through an infected person’s saliva, nasal mucus or sputum.

How can I avoid getting the virus?
You should:

  • Wash your hands often
  • Avoid touching your eyes, nose and mouth with unwashed hands
  • Avoid close contact with people who are sick
  • Disinfect frequently touched surfaces

Is there anything else I should do?
Get your flu vaccine. Although it won’t help ward off EV-D68, it will help medical staff diagnose you if you get a severe respiratory infection.

For more information
For more information about EV-D68, click here. To find out how to get your flu vaccine, click here.