Background: Multidrug-resistant organisms (MDROs) are an important health care issue. Patients in Western societies often present an increased morbidity of chronic conditions accompanied by poor immune status and the use of devices. In particular, patients in palliative care (PC) are at greater risk of MDRO colonization, due to accompanying special devices and being hospitalized. Objective: To gain an overview of the literature regarding MDROs in PC. Design: : Systematic review Data sources: : On the 19th of October 2019 the databases “ PubMed” and “ CINAHL” were used to identify studies reporting on MDROs in PC; the search was updated on 16th of May 2020. Results: Seventeen out of 486 articles were included. Six represent qualitative data, 10 quantitative data, and one a mixed methods approach. Prevalence data range from 4.0% to 18%. MDRO colonization has a negative impact on patients and families. It leads to uncertainties and higher workload by staff members. Strategies for the management of MDROs in the field of PC are predominantly available for methicillin-resistant Staphylococcus aureus . Not even half of institutions utilize existing protocols. Recommendations for dealing with MDROs indicate required staff and time resources as well as information, communication, and specific knowledge. Conclusion: There is a great need for studies examining the prevalence of all MDROs in the PC setting. Additionally, not only patients but also a public enlightenment on MDROs should be provided to decrease knowledge gaps and therefore reduce transmission on MDROs.

Aim: Multidrug‐resistant organisms (MDRO) deserve special attention in health‐care facilities for children with life‐limiting conditions because these children have an increased risk for colonisation. To avoid nosocomial transmissions to other inpatients, single‐room isolation is usually recommended. In the context of paediatric palliative care (PPC), such isolation counters the aim of participation in social activities for the patients. This study aimed to determine the prevalence of MDRO, the predictive value of risk factors and the incidence of nosocomial infections and nosocomial colonisations on a PPC inpatient unit applying a special hygiene concept that enables participation in social activities through risk‐adaption and barrier nursing.Methods: Two‐year surveillance with MDRO screening of all intakes (N = 386) of a PPC unit on the day of admission and discharge. To determine the predictive value of pre‐defined risk factors, logistic regression analyses were calculated. Receiver operating characteristic analyses were performed to determine the predictive power of the number of risk factors on the presence of MDRO.Results: The rate of MDRO colonisation at admission was 12.7%; previous positive MDRO screening was the only significant individual risk factor. Over the 2‐year period, no MDRO‐related nosocomial infections occurred; nosocomial colonisation incidence density was 0.6.Conclusion: Results demonstrate that patients with at least one risk factor have to be cared for by barrier nursing until MDRO screening results are negative. Following these guidelines prevents nosocomial MDRO transmission.

Multidrug resistant pathogens are a large-scale healthcare issue. In particular, children with life-limiting conditions have a significantly increased risk of multidrug resistant pathogen colonization. Official hygiene requirements recommend children, who are colonized with multidrug resistant pathogens, to be isolated. In the context of pediatric palliative care, such isolation adversely affects the aim of social participation. To overcome this challenge of conflicting interests on a pediatric palliative care inpatient unit, a hygiene concept for patients colonized with multidrug resistant pathogens, called PALLINI, was implemented. The aim of this study was to identify the nurses’ attitudes and opinions toward PALLINI. Nurses (N = 14) from the pediatric palliative care unit were queried in guideline-oriented interviews. Interviews were analyzed qualitatively by means of content analysis. The following four categories were identified: (1) safety, (2) effort, (3) quality of care, and (4) participation. All categories demonstrated ambivalence by nursing staff regarding PALLINI. Ambivalence arose from guaranteeing infection control versus noncompliance by the families, additional workload for patients with multidrug resistant pathogens versus lack of resources, impaired relationship with the parents versus enabling better care for the child, as well as enabling some limited contact versus the larger goal of genuine social participation. Despite this, nurses reported the importance of arranging everyday-life for the patients so that they experience as much social participation as possible. The implementation of a new hygiene concept is challenging. Despite positive reception of PALLINI from the nurses, ambivalence remained. Addressing these ambivalences may be critical to best implement the new hygiene concept.

Pediatric Palliative Care (PPC) addresses children, adolescents, and young adults with a broad spectrum of underlying diseases. A substantial proportion of these patients have irreversible conditions accompanied by Severe Neurological Impairment (SNI). For the treatment of pain and dyspnea, strong opioids are widely used in PPC. Nonetheless, there is considerable uncertainty regarding the opioid-related side effects in pediatric patients with SNI, particularly concerning Opioid-Induced Respiratory Depression (OIRD). Research on pain and OIRD in pediatric patients with SNI is limited. Using scoping review methodology, we performed a systematic literature search for OIRD in pediatric patients with SNI. Out of n = 521 identified articles, n = 6 studies were included in the review. Most studies examined the effects of short-term intravenous opioid therapy. The incidence of OIRD varied between 0.13% and 4.6%; besides SNI, comorbidities, and polypharmacy were the most relevant risk factors. Additionally, three clinical cases of OIRD in PPC patients receiving oral or transdermal opioids are presented and discussed. The case reports indicate that the risk factors identified in the scoping review also apply to adolescents and young adults with SNI receiving low-dose oral or transdermal opioid therapy. However, the risk of OIRD should never be a barrier to adequate symptom relief. We recommend careful consideration and systematic observation of opioid therapy in this population of patients.

Background: In light of the increasing importance of measuring, assuring, and improving the quality of care, this study aimed to evaluate the outcome of care provided at a specialized inpatient PPC unit in consideration of the three PPC core treatment goals: (i) reduction in symptom burden, (ii) improvement of the quality of life, and (iii) strengthening caregiver competency. Methods: Prospective single-center study. Data were collected using the QUASI, a shorter version of the validated FAmily-CEnTered multidimenSional Outcome measure For Pediatric Palliative Care (FACETS-OF-PPC). From 20 October 2020 to 31 December 2024, QUASI was completed by nurses at admission (pre-survey) to an 8-bed specialized inpatient PPC unit and again on the day of discharge (post-survey). Descriptive statistics and the Wilcoxon signed-rank test were used to identify differences between pre- and post-surveys. In addition to outcome evaluation, psychometric properties of the Caregiver Competencies subscale were assessed (internal consistency and confirmatory factor analysis). Results: Pre- and post-data of n = 574 patients have been assessed. Among patients with initially high symptom load, significant improvement in all assessed symptoms could be achieved. Patients with initially low symptom load showed significant improvements in agitation (p = 0.043), pain (p < 0.001), sleep disturbances (p < 0.001), and other symptoms (p = 0.015). Mean scores for the items regarding quality of life also improved significantly between admission and discharge. Caregiver’s competency also increased significantly (p < 0.001). Conclusions: Findings suggest that the QUASI can serve as a feasible approach for documenting PPC quality, as it covers core dimensions of PPC very effectively, with the potential to inform clinical practice. Further validation is warranted.

Background: Pediatric Palliative Care (PPC) patients represent a highly heterogeneous population. Depending on the specific needs of the child and their family, PPC is provided at different levels, ranging from a basic PPC approach to highly specialized PPC in tertiary care centers. However, data on patients treated in specialized inpatient PPC units remain limited. This study aimed to further characterize this patient population, focusing on diagnostic spectrum, comorbidities, device dependency, admission patterns and mortality. Methods: A retrospective single-center study was conducted, including all patients admitted to an 8-bed specialized PPC unit at a tertiary, university-affiliated pediatric hospital in Germany between 2012 and 2023. Patient characteristics, underlying and secondary diagnoses based on the ICD-10-GM, device dependency, and admission patterns were analyzed descriptively. Results: N = 669 patients (mean age: 9.3; range: 0.03–33.5 years), cor-responding to N = 2,151 admissions, were analyzed. 47.7% of patients ( n = 319) were readmitted at least once; the average number of inpatient stays was 3.2 (SD 4.7; range: 1–57) per patient. The mean length of stay was 12.6 days (SD 13.3; range 0–186) days. A total of 212 patients (31.7%) had diagnoses classified under chapter XVII (Congenital malformations, deformations, and chromosomal abnormalities), followed by 27.1% ( n = 181) under chapter VI (Diseases of the nervous system) and 18.5% ( n = 124) under chapter XVI (Certain conditions originating in the perinatal period). Nearly all patients (98.4%) had at least one secondary diagnosis, with a mean of 9.87 (range 1–23) secondary diagnoses per patient. A total of 74.6% of participants had at least one device. A total of 154 patients (23.0%) died within the observational period, and 57 (37.0%) were in the PPC unit. The mean distance between the patients' homes and the PPC unit was 69.7 (range 0–494.3) km. Conclusions: PPC patients exhibit profound multimorbidity, with the complexity of their healthcare needs necessitating specialized multidisciplinary care and a high level of clinical expertise within specialized PPC structures.