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Importance of risk adjusting central line-associated bloodstream infection rates in children

Published online by Cambridge University Press:  07 October 2024

Lakshmi Srinivasan Open the ORCID record for Lakshmi Srinivasan [Opens in a new window] ,
Ashley Oliver ,
Yuan-shung V Huang Open the ORCID record for Yuan-shung V Huang [Opens in a new window] ,
Di Shu ,
Kait M Donnelly ,
Cecelia Harrison Open the ORCID record for Cecelia Harrison [Opens in a new window] ,
Amy L. Roberts  and
Ron Keren
Lakshmi Srinivasan*
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, PA, USA Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
Ashley Oliver
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Yuan-shung V Huang
Affiliation:
Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Di Shu
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, PA, USA Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
Kait M Donnelly
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Cecelia Harrison
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Amy L. Roberts
Affiliation:
Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Ron Keren
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, PA, USA Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
*
Corresponding author: Lakshmi Srinivasan; Email: [email protected]
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Abstract

Objective:

Central line-associated bloodstream infection (CLABSI) is one of the most prevalent pediatric healthcare-associated infections and is used to benchmark hospital performance. Pediatric patients have increased in acuity and complexity over time. Existing approaches to risk adjustment do not control for individual patient characteristics, which are strong predictors of CLABSI risk and vary over time. Our objective was to develop a risk adjustment model for CLABSI in hospitalized children and compare observed to expected rates over time.

Design and Setting:

We conducted a prospective cohort study using electronic health record data at a quaternary Children’s Hospital.

Patients:

We included hospitalized children with central catheters.

Methods:

Risk factors identified from published literature were considered for inclusion in multivariable modeling based on association with CLABSI risk in bivariable analysis and expert input. We calculated observed and expected (risk model-adjusted) annual CLABSI rates.

Results:

Among 16,411 patients with 520,209 line days, 633 patients experienced 796 CLABSIs. The final model included age, behavioral health condition, non-English speaking, oncology service, port catheter type, catheter dwell time, lymphatic condition, total parenteral nutrition, and number of organ systems requiring ICU level care. For every organ system receiving ICU level care the odds ratio for CLABSI was 1.24 (95% CI 1.12–1.37). Although not statistically different, observed rates were lower than expected rates for later years.

Conclusions:

Failure to adjust for patient factors, particularly acuity and complexity of disease, may miss clinically significant differences in CLABSI rates, and may lead to inaccurate interpretation of the impact of quality improvement efforts.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 45 , Issue 11 , November 2024 , pp. 1280 - 1285
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

Meeting Presentation: This work has been presented at Pediatric Academic Societies, Washington DC in April 2023 and Solutions for Patient Safety, St. Louis, MO in May 2023.

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