Lessons learned from a hospital‐wide review of blood stream infections for paediatric central line‐associated blood stream infection prevention

Abstract

Aim Bacteraemia episodes were assessed to calculate a hospital‐wide central line‐associated blood stream infection (CLABSI) rate per 1000 catheter‐days. Secondary objectives were to describe risk factors, microbiology and outcomes of children with CLABSI. Methods A retrospective study was conducted at an Australian tertiary paediatric hospital in children <18 years who had blood culture sampling during the 2‐year period, 2014–2015. All blood culture results were extracted from the hospital's laboratory information system. National Healthcare Safety Network Centres for Disease Control and Prevention definitions for bacteraemia classification were used. Central venous access device (CVAD) insertion and removal dates were obtained from a surgical electronic database and anaesthetic records and then manually validated. Results Of 11 774 processed blood culture bottles, 207 episodes of blood stream infection were observed. Eighty‐five (41%) episodes were community‐acquired bacteraemia (CA‐B) and 122 (59%) health care‐associated bacteraemia (HA‐B), of which 73 (35%) were CLABSI. The hospital‐wide CLABSI rate was 0.62 per 1000 catheter‐days (95% confidence interval: 0.49–0.77). Conditions associated with CLABSI were malignancy (n = 45, 62%) and gastrointestinal failure (n = 6, 8%). Thirty‐three (45%) CLABSI episodes developed in an outpatient setting. Conclusions HA‐B has a significant impact on child health, exceeding the number of CA‐B at our hospital. Children with CVADs are vulnerable in both the inpatient and outpatient settings. Collecting robust data for a hospital‐wide CLABSI rate is important to understand the full spectrum of paediatric CLABSI. The value of validating data using both electronic and manual methods is demonstrated.

Incidence of Hospital-Acquired Conditions During Pediatric Clinical Research Inpatient Hospitalizations: A Matched Cohort Study

“…Despite this, our results underscore the need for improved vascular catheter protocols to prevent hospital-acquired infections across pediatric inpatient settings. 11,33,34 Our results indicating higher rates of HAC for research stays may be explained, at least in part, by clinical differences between research and nonresearch hospitalizations. It is unknown whether patients enrolled in clinical research may be higher acuity, with worse severity or more advanced disease than patients not enrolled in a research study.…”

“…In addition, there were relatively few events overall resulting in low statistical power and wide CIs for individual HAC. Despite this, our results underscore the need for improved vascular catheter protocols to prevent hospital-acquired infections across pediatric inpatient settings 11,33,34 …”

“…Sociodemographic Characteristics Among Research and nonresearch Hospitalizations at 28 PHIS Hospitals (N =33,447) …”

“…Unadjusted HACs Incidence and Incidence Rates Among Inpatient Research Hospitalizations and Nonresearch Hospitalizations at 28 PHIS Hospitals (N =33,447) …”