189: Survey of Infection Control Precautions for Patients with Severe Combined Immune Deficiency
Bibliographic record
Abstract
Severe combined immune deficiency (SCID) is caused by an array of genetic disorders resulting in a diminished adaptive immune system due to impaired T and/or B lymphocytes. To prevent transmission of infections in SCID patients, standardized infection control precautions should be implemented. Although such policies have been described for other vulnerable pediatric populations such as hematopoietic stem cell transplant (HSCT) and oncology patients, SCID-specific infection control policies have not yet been described. To describe SCID-specific infection control precautions internationally, and from this descriptive data, propose future evidence-based research for SCID infection control practices/guidelines. A survey regarding SCID-specific isolation protocols was disseminated online through clinical immunodeficiency organizations. Descriptive data were collected and analyzed using SelectSurvey and Microsoft Excel. Our institutional Research and Ethics Board approved the study, and participant consent was obtained at the beginning of each survey. 73 responses were obtained, with 54% of responses from the United States, 14% from Canada, and the remainder from 14 other countries. Only 50% of respondents had a SCID-specific infection control protocol at their center. Most physicians (88%) received training on these protocols, but only 54% of nurse practitioners (NPs) and 46% of nurses received training. The majority (89%) of SCID inpatients are admitted to private rooms, with HEPA filters in 57% of rooms, positive pressure airflow in 46% and anterooms in 54%. Required personal protective equipment (PPE) for staff included non-sterile gowns (66%), surgical masks (72%) and non-sterile gloves (62%). 48% of respondents do not require caregivers to wear PPE if the patient is not contagious. Most centers (62%) allow visitors, but with visitor restrictions. There was significant variability regarding indications for discharge of a clinically well SCID patient: 31% would not discharge home, 11% had no restrictions for discharge, while the remainder allow clinically well SCID patients to be home under certain conditions, such as requiring that they live close (31%) and no visitors are allowed (33%). Significant variability of SCID-specific infection control precautions was found between different treatment centers in Canada and internationally. There is little evidence-based data regarding the safest environment to prevent infection in SCID patients, and it must be considered that protocols instituted will have significant impact on infection risk, family well-being, the child's development and cost of care. Further multi-center research is required to determine the safest and healthiest environment for these children, in order for evidence-based SCID-specific infection control protocols to be implemented.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".