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Novel risk factors for central-line associated bloodstream infections in critically ill children

Published online by Cambridge University Press:  05 November 2019

Charlotte Z. Woods-Hill Open the ORCID record for Charlotte Z. Woods-Hill [Opens in a new window] ,
Lakshmi Srinivasan ,
Emily Schriver ,
Tanya Haj-Hassan ,
Orysia Bezpalko  and
Julia S. Sammons
Charlotte Z. Woods-Hill*
Affiliation:
Division of Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
Lakshmi Srinivasan
Affiliation:
University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Emily Schriver
Affiliation:
Center for Healthcare Quality and Analytics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania The Medicine Data Analytics Center, University of Pennsylvania Philadelphia, Pennsylvania
Tanya Haj-Hassan
Affiliation:
Division of Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Orysia Bezpalko
Affiliation:
Performance Improvement, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Julia S. Sammons
Affiliation:
Infection Prevention and Control, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
*
Author for correspondence: Charlotte Z. Woods-Hill, Email: [email protected]
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Abstract

Objective:

Central-line–associated bloodstream infections (CLABSI) cause morbidity and mortality in critically ill children. We examined novel and/or modifiable risk factors for CLABSI to identify new potential targets for infection prevention strategies.

Methods:

This single-center retrospective matched case-control study of pediatric intensive care unit (PICU) patients was conducted in a 60-bed PICU from April 1, 2013, to December 31, 2017. Case patients were in the PICU, had a central venous catheter (CVC), and developed a CLABSI. Control patients were in the PICU for ≥2 days, had a CVC for ≥3 days, and did not develop a CLABSI. Cases and controls were matched 1:4 on age, number of complex chronic conditions, and hospital length of stay.

Results:

Overall, 72 CLABSIs were matched to 281 controls. Univariate analysis revealed 14 risk factors, and 4 remained significant in multivariable analysis: total number of central line accesses in the 3 days preceding CLABSI (80+ accesses: OR, 4.8; P = .01), acute behavioral health needs (OR, 3.2; P = .02), CVC duration >7 days (8–14 days: OR, 4.2; P = .01; 15–29 days: OR, 9.8; P < .01; 30–59 days: OR, 17.3; P < .01; 60–89 days: OR, 39.8; P < .01; 90+ days: OR, 4.9; P = .01), and hematologic/immunologic disease (OR, 1.5; P = .05).

Conclusions:

Novel risk factors for CLABSI in PICU patients include acute behavioral health needs and >80 CVC accesses in the 3 days before CLABSI. Interventions focused on these factors may reduce CLABSIs in this high-risk population.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 1 , January 2020 , pp. 67 - 72
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: Elements of this investigation were presented as an oral abstract the 2019 Society for Healthcare Epidemiology of America conference on April 24, 2019, in Boston, Massachusetts.

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