Protecting Pediatric Patients from Healthcare-Associated Infections in the Hospital and at Home

Aaron M. Milstone, M.D. , M.H.S.


“The insights my team and I are gaining from our AHRQ-funded research is helping us identify how infections develop among infants and children who are already very sick. This knowledge will allow us to build on infection-prevention practices for clinicians and parents to hopefully further reduce—or even eliminate—these risks in the future.”


Critically ill infants and children who need long-term treatment such as chemotherapy are especially susceptible to developing infections.  With AHRQ funding, Aaron M. Milstone, M.D., M.H.S., is identifying and reducing the risk of infections for very sick children in both hospital intensive care units (ICUs) and at home.  

An Associate Professor of Pediatrics at Johns Hopkins University School of Medicine in Baltimore and an epidemiologist at The Johns Hopkins Hospital, Dr. Milstone is also exploring how to slow the spread of bacteria that have become resistant to  antibiotics. These multi-drug resistant bacteria can make infections harder to treat.  

In one of his three AHRQ-funded grants,  Dr. Milstone and his team are examining how changes in diagnostic testing for hospitalized children suspected of having sepsis can reduce the overall use of antibiotics. Sepsis is the body’s extreme reaction to an infection.  It is dangerous, difficult to diagnose accurately at an early stage, and can progress quickly.

Because sepsis can be treated effectively with antibiotics, clinicians often prescribe these drugs when they initially suspect a sick child may be developing the condition, which can potentially lead to overprescribing. This is why improving the way that clinicians evaluate pediatric ICU patients for early signs of sepsis can help them prescribe antibiotics more appropriately.  To this end, Dr. Milstone is working with 14 hospitals on the Bright STAR Collaborative to test whether new guidelines can help lead to lower antibiotic use and fewer cases of Clostridium difficile, a serious gut infection that’s linked to antibiotic use.

Dr. Milstone is also working on an AHRQ-funded project to reduce the risk of Staphylococcus aureus (S. aureus) transmission from parents to their premature infants in ICUs. Skin-to-skin contact between parents and infants is encouraged to promote bonding, but this beneficial activity can also increase exposure to a potentially life-threatening bacteria. To reduce this risk, Milstone and his team are testing the value of applying preventive ointment into parents’ noses to protect premature infants from infection with S. aureus.

In another project designed to keep pediatric cancer patients safer when they are cared for at home, Dr. Milstone is working with Marlene Miller, M.D., M.Sc., who chairs the department of pediatrics at University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, Ohio.  They are testing whether best practices and routine use of rubbing alcohol-embedded caps on intravenous lines can reduce central line-associated bloodstream infections. This ongoing AHRQ-funded project includes 16 pediatric oncology clinics.

Dr. Milstone is a fellow of the American Academy of Pediatrics, the Infectious Diseases Society of America, and the Society for Healthcare Epidemiology of America (SHEA).  He received the 2018 SHEA Mentor Scholar Award for his dedication to helping establish a new generation of scientists in infection prevention to promote research and advance the science of patient safety for children.

Principal Investigator: Aaron M. Milstone, M.D. M.H.S., Associate Professor of Pediatrics, Johns Hopkins University School of Medicine; Associate Hospital Epidemiologist, The Johns Hopkins Hospital
Institution: Johns Hopkins University School of Medicine, Johns Hopkins Armstrong Institute for Patient Safety and Quality
Grantee Since: 2014
Type of Grant: Various

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Page last reviewed November 2018
Page originally created October 2018
Internet Citation: Protecting Pediatric Patients from Healthcare-Associated Infections in the Hospital and at Home. Content last reviewed November 2018. Agency for Healthcare Research and Quality, Rockville, MD.
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