Resident Levine Children's Hospital Charlotte, North Carolina, United States
Background: Congenital cytomegalovirus (cCMV) infection is the most common congenital infection and the 2nd leading cause of childhood hearing loss.Identification and antiviral treatment of cCMVcan help prevent progression of hearing loss. Objective: Our goal was to screen 80% of babies with failed hearing screens forcCMVviaurine or saliva PCR at anurbantertiary center and 9regionalnewborn nurseries. We aimed to refer 90% of infected newbornsfor infectious disease evaluation and treatment within 2 weeks. Design/Methods: We used Model for Improvement methodology and rapid cycle PDSAs under the guidance of a multi-disciplinary team of stakeholders. PDSA cycles includedcreation of a standardized, evidence-basedorder set, staff education and follow-up audits with provider feedback. Our intervention began atour tertiary center followed byexpansion to the regional sites.Collected data included %failed hearing screens tested, % infected infants referredfor evaluation, subjective providerfeedbackon the process and added workload. Results: Appropriate cCMV testing increased from 7% to 73% from 4/2022 to 11/2022 (Fig 1). Of the 273 newborns that failed screens, 192 were successfully screened. 3 infants who screened positive for CMV were successfully referred for evaluation.
Conclusion(s): Implementation of a standardized process for cCMV testing in newborns with failed hearing screens proved successful. All cCMVpositive patients were successfully referred to infectious disease clinic for further treatment. Future PDSAs will focus on increasing process reliability to decrease variation and expanding this process to further regional sites.
