Using Quality Improvement to Implement a Standardized Approach to Neonatal Herpes Simplex Virus

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Quality Improvement

Background:

• Neonatal herpes simplex virus (HSV) infections present significant mortality and morbidity risks.
• Current treatment with acyclovir carries potential toxicity, necessitating careful management.
• Adherence to established guidelines for HSV testing and treatment in neonates is suboptimal.

Purpose of the Study:

• To enhance the percentage of neonates (0-60 days) tested and treated for HSV according to guidelines from 40% to 80%.
• To implement and evaluate interventions for improving neonatal HSV management protocols.
• To reduce unnecessary acyclovir use in non-high-risk infants while ensuring timely treatment for high-risk cases.

Main Methods:

• A quality improvement project utilizing multiple plan-do-study-act cycles in a children's hospital.
• Interventions focused on provider buy-in, guideline accessibility, and accurate identification of high-risk infants.
• Run charts tracked guideline adherence; pre- and post-intervention acyclovir use compared using chi-squared tests; delayed treatment monitored as a balancing measure.

Main Results:

• Median adherence to HSV management guidelines increased from 40% to 80% within 8 months.
• Acyclovir use decreased significantly in non-high-risk infants (26% to 7.9%, P < .001).
• No significant change in acyclovir use for high-risk infants (73%-83%, P = .15); no delayed acyclovir initiation in HSV-positive cases.

Conclusions:

• Point-of-care guideline availability and provider engagement interventions improved adherence to neonatal HSV management guidelines.
• These interventions successfully decreased acyclovir use in non-high-risk infants.
• Further research is needed to validate these findings in diverse clinical settings.