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

Woods-Hill, Charlotte; Srinivasan, Lakshmi; Schriver, Emily; Haj-Hassan, T; Bezpalko, Orysia; Sammons, Julia Shaklee

doi:10.1017/ice.2019.302

Cited by 9 publications

(7 citation statements)

References 40 publications

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“…Given this population's high-risk of morbidity and mortality from bloodstream infections, clinicians are understandably hesitant to reduce diagnostic testing for bacteremia (35)(36)(37). However, immunocompromised PICU patients are also at high risk of poor outcomes associated with overtesting, such as excessive entry into CVCs, adverse effects of unnecessary antibiotics such as kidney injury, and antimicrobial resistance (38,39).…”

Section: (25/26)mentioning

confidence: 99%

Consensus Recommendations for Blood Culture Use in Critically Ill Children Using a Modified Delphi Approach*

Woods-Hill

Koontz

Voskertchian

et al. 2021

Pediatric Critical Care Medicine

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Blood cultures are fundamental in evaluating for sepsis, but excessive cultures can lead to false-positive results and unnecessary antibiotics. Our objective was to create consensus recommendations focusing on when to safely avoid blood cultures in PICU patients. DESIGN:A panel of 29 multidisciplinary experts engaged in a two-part modified Delphi process. Round 1 consisted of a literature summary and an electronic survey sent to invited participants. In the survey, participants rated a series of recommendations about when to avoid blood cultures on five-point Likert scale. Consensus was achieved for the recommendation(s) if 75% of respondents chose a score of 4 or 5, and these were included in the final recommendations. Any recommendations that did not meet these a priori criteria for consensus were discussed during the in-person expert panel review (Round 2). Round 2 was facilitated by an independent expert in consensus methodology. After a review of the survey results, comments from round 1, and group discussion, the panelists voted on these recommendations in real-time. SETTING: Experts' institutions; in-person discussion in Baltimore, MD. SUBJECTS:Experts in pediatric critical care, infectious diseases, nephrology, oncology, and laboratory medicine. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Of the 27 original recommendations, 18 met criteria for achieving consensus in Round 1; some were modified for clarity or condensed from multiple into single recommendations during Round 2. The remaining nine recommendations were discussed and modified until consensus was achieved during Round 2, which had 26 real-time voting participants. The final document contains 19 recommendations. CONCLUSIONS:Using a modified Delphi process, we created consensus recommendations on when to avoid blood cultures and prevent overuse in the PICU. These recommendations are a critical step in disseminating diagnostic stewardship on a wider scale in critically ill children.

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Section: (25/26)mentioning

confidence: 99%

Consensus Recommendations for Blood Culture Use in Critically Ill Children Using a Modified Delphi Approach*

Woods-Hill

Koontz

Voskertchian

et al. 2021

Pediatric Critical Care Medicine

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“…Extrinsic risk factors are variables linked with central line placement or maintenance that are possibly controllable. These include: prolonged hospitalization before central line insertion, parenteral nutrition, mill lumen central lines, lack of maximal barriers for central line insertion, femoral or internal jugular access site, multiple central lines, heavy microbial colonization at the insertion site, and central line insertion in an intensive care unit or emergency department [11].…”

Section: Risk Factors For Clabsimentioning

confidence: 99%

Prevention and Nursing Management for Central Line Associated Blood Stream Infection

Sakharkar

Sharma

Mude³

et al. 2021

JPRI

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Central line associated blood stream infection (CLABSI), is a substantial contributor to in-hospital morbidity and death, as well as increased cost and length of stay in the intensive care unit (ICU). CLABSIs are one of the most deadly for each infection is expected to have a mortality rate of 12-25 percent. CLABSI prevention is important, and nurses play a vital role. Nurses are required to complete initial training as well as annual competence tests for central venous catheter protocol and other skills to ensure that they are delivering direct care to patients using the most up-to-date evidence-based practices. Conclusion: CLABSI prevention bundles are the best method for implementing many interventions at once in addition to standardizing practice. Standard prevention bundles in addition to routine CLABSI education for staff are the most effective methods for preventing infection; it is inevitable that compliance with bundles will vary across healthcare institutions.

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“…Racial disparities in the associations with CLABSI risk were observed in a single-center pediatric study to develop a clinical prediction model for CLABSI, in a national database of pediatric patients with gastroschisis and CLABSI, and in the Pediatric Health Information System database . Additionally, in a pediatric intensive care unit population, a higher tendency of CLABSI was observed in patients whose primary language was not English . In these studies, the understanding and mitigation of disparities were not the primary aims.…”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17] Additionally, in a pediatric intensive care unit population, a higher tendency of CLABSI was observed in patients whose primary language was not English. 18 In these studies, the understanding and mitigation of disparities were not the primary aims.…”

mentioning

confidence: 99%

Identifying and Mitigating Disparities in Central Line–Associated Bloodstream Infections in Minoritized Racial, Ethnic, and Language Groups

et al. 2023

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ImportanceAlthough inequitable care due to racism and bias is well documented in health care, the impact on health care–associated infections is less understood.ObjectiveTo determine whether disparities in first central catheter–associated bloodstream infection (CLABSI) rates existed for pediatric patients of minoritized racial, ethnic, and language groups and to evaluate the outcomes associated with quality improvement initiatives for addressing these disparities.Design, Setting, and ParticipantsThis cohort study retrospectively examined outcomes of 8269 hospitalized patients with central catheters from October 1, 2012, to September 30, 2019, at a freestanding quaternary care children’s hospital. Subsequent quality improvement interventions and follow-up were studied, excluding catheter days occurring after the outcome and episodes with catheters of indeterminate age through September 2022.ExposuresPatient self-reported (or parent/guardian-reported) race, ethnicity, and language for care as collected for hospital demographic purposes.Main Outcomes and MeasuresCentral catheter–associated bloodstream infection events identified by infection prevention surveillance according to National Healthcare Safety Network criteria were reported as events per 1000 central catheter days. Cox proportional hazards regression was used to analyze patient and central catheter characteristics, and interrupted time series was used to analyze quality improvement outcomes.ResultsUnadjusted infection rates were higher for Black patients (2.8 per 1000 central catheter days) and patients who spoke a language other than English (LOE; 2.1 per 1000 central catheter days) compared with the overall population (1.5 per 1000 central catheter days). Proportional hazard regression included 225 674 catheter days with 316 infections and represented 8269 patients. A total of 282 patients (3.4%) experienced a CLABSI (mean [IQR] age, 1.34 [0.07-8.83] years; female, 122 [43.3%]; male, 160 [56.7%]; English-speaking, 236 [83.7%]; LOE, 46 [16.3%]; American Indian or Alaska Native, 3 [1.1%]; Asian, 14 [5.0%]; Black, 26 [9.2%]; Hispanic, 61 [21.6%]; Native Hawaiian or Other Pacific Islander, 4 [1.4%]; White, 139 [49.3%]; ≥2 races, 14 [5.0%]; unknown race and ethnicity or refused to answer, 15 [5.3%]). In the adjusted model, a higher hazard ratio (HR) was observed for Black patients (adjusted HR, 1.8; 95% CI, 1.2-2.6; P = .002) and patients who spoke an LOE (adjusted HR, 1.6; 95% CI, 1.1-2.3; P = .01). Following quality improvement interventions, infection rates in both subgroups showed statistically significant level changes (Black patients: −1.77; 95% CI, −3.39 to −0.15; patients speaking an LOE: −1.25; 95% CI, −2.23 to −0.27).Conclusions and RelevanceThe study’s findings show disparities in CLABSI rates for Black patients and patients who speak an LOE that persisted after adjusting for known risk factors, suggesting that systemic racism and bias may play a role in inequitable hospital care for hospital-acquired infections. Stratifying outcomes to assess for disparities prior to quality improvement efforts may inform targeted interventions to improve equity.

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

Cited by 9 publications

References 40 publications

Consensus Recommendations for Blood Culture Use in Critically Ill Children Using a Modified Delphi Approach*

Consensus Recommendations for Blood Culture Use in Critically Ill Children Using a Modified Delphi Approach*

Prevention and Nursing Management for Central Line Associated Blood Stream Infection

Identifying and Mitigating Disparities in Central Line–Associated Bloodstream Infections in Minoritized Racial, Ethnic, and Language Groups

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