Risk-adjusted monitoring of blood-stream infection in paediatric intensive care: a data linkage study

Area of Science:

• Infection control and hospital epidemiology
• Pediatric critical care medicine
• Public health surveillance

Background:

• National monitoring of infection control quality in pediatric intensive care units (PICUs) necessitates risk-adjusted rate comparisons.
• Evaluating the impact of risk-adjustment and outcome definition on bloodstream infection (BSI) comparisons is crucial for developing effective national monitoring systems.

Purpose of the Study:

• To assess the effect of risk-adjustment and outcome definition on bloodstream infection (BSI) rate comparisons in pediatric intensive care units (PICUs).
• To determine the feasibility of linking national audit risk-factor data with laboratory BSI records for national monitoring.

Main Methods:

• Linked admission data from two children's hospitals (2003-2010) with laboratory BSI records using multiple identifiers.
• Calculated trends of PICU-acquired BSI, defined as infections occurring from day 2 post-admission to 2 days post-discharge.
• Compared rates of all PICU-acquired BSI versus clinically significant BSI in one PICU.

Main Results:

• 1,428 of 20,924 admissions (6.8%) linked to 1,761 PICU-acquired BSI episodes.
• Crude BSI rate ratio between PICUs was 1.15, increasing to 1.26 after risk-adjustment.
• PICU-acquired BSI rates were 13.44/1000 bed-days (PICU 1) and 18.05/1000 bed-days (PICU 2); 41% of PICU 2 BSIs were clinically significant.
• Annual BSI rates decreased by 10% (skin organisms) and 8% (non-skin organisms) from 2003-2010.

Conclusions:

• Risk-adjustment and standardized outcome measures are essential for equitable BSI rate comparisons between PICUs.
• Linking risk-factor data with BSI surveillance data is feasible and supports national risk-adjusted monitoring.
• This approach can enhance the quality of infection control monitoring in PICUs nationwide.