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Risk Factors for Central Venous Catheter-Associated Bloodstream Infection in Pediatric Patients: A Cohort Study
Jillian Hansen Carter1, Joanne Marie Langley2,3,4, Stefan Kuhle2,3,5,4
1Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Central-line-associated bloodstream infections (CLABSI) in hospitalized children significantly decreased by 84% over 18 years. This reduction in CLABSI was linked to a hand hygiene campaign, identifying key risk factors.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Epidemiology
- Infection Prevention and Control
Background:
- Central-line-associated bloodstream infections (CLABSI) are a significant concern in pediatric healthcare settings.
- Understanding the incidence and risk factors for CLABSI is crucial for effective prevention strategies.
Purpose of the Study:
- To investigate the incidence of CLABSI in hospitalized children over an 18-year period.
- To identify specific risk factors associated with CLABSI development in this population.
- To evaluate trends in CLABSI rates and their potential correlation with public health initiatives.
Main Methods:
- A prospective cohort study was conducted at a pediatric tertiary care center from 1995 to 2013.
- Data on patients aged 0-18 years with central venous catheters (CVCs) were prospectively collected.
- Cox proportional hazards regression analysis was employed to determine CLABSI risk factors.
Main Results:
- A total of 5,648 patients were included, with 385 developing CLABSI (0.74 per 1,000 line days).
- CLABSI rates declined by 84% from 1995 (4.87 per 1,000 line days) to 2013 (0.78 per 1,000 line days).
- A temporal association was observed between CLABSI reduction and a hand hygiene promotion campaign. CVC type, number of lumens, dressing type, insertion vein, and critical care unit stay were significant risk factors.
Conclusions:
- Hospital-wide surveillance over 18 years revealed a significant decrease in CLABSI rates among hospitalized children.
- The observed reduction in CLABSI was temporally associated with a hand hygiene campaign.
- Identifying high-risk children and implementing targeted interventions, including hand hygiene, are essential for CLABSI prevention.
Abstract:
OBJECTIVE To examine the incidence of central-line-associated bloodstream infection (CLABSI) over time and to determine risk factors for CLABSI in hospitalized children. DESIGN Prospective cohort study. SETTING Pediatric tertiary care referral center in Halifax, Nova Scotia, serving a population of 2.3 million. PARTICIPANTS Patients ages 0-18 years with central venous catheters (CVCs) inserted at this facility between 1995 and 2013. METHODS Participants were followed from CVC insertion to CLABSI event or until CVC removal. Data were prospectively collected by clinicians, infection prevention and control staff, and nursing staff for the purposes of patient care, surveillance, and quality improvement. Cox proportional hazards regression was used to identify risk factors for CLABSI. RESULTS Among 5,648 patients, 385 developed CLABSI (0.74 CLABSI per 1,000 line days; or 3.87 per 1,000 in-hospital line days). Most infections occurred within 60 days of insertion. CLABSI rates decreased from 4.87 per 1,000 in-hospital line days in 1995 to 0.78 per 1,000 in-hospital line days in 2013, corresponding to an 84% reduction. A temporal association of CLABSI reduction with a hand hygiene promotion campaign was identified. CVC type, number of lumens, dressing type, insertion vein, and being in the critical care unit were statistically significantly associated with CLABSI. CONCLUSIONS Hospital-wide surveillance over an 18-year period identified children at highest risk for CLABSI and decreasing risk over time; this decrease was temporally associated with a hand hygiene campaign. Infect Control Hosp Epidemiol 2016;37:939-945.
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