Device Exposure and Patient Risk Factors' Impact on the Healthcare-Associated Infection Rates in PICUs

Area of Science:

• Infectious Diseases
• Pediatric Critical Care
• Public Health

Background:

• Healthcare-associated infections (HAIs) linked to device use (DA-HAIs) significantly increase mortality, hospital stay, and costs in pediatric intensive care units (PICUs).
• Device use is an established risk factor for HAIs in critically ill children.

Purpose of the Study:

• To evaluate the impact of HAI Zero Bundles on DA-HAI rates in Spanish PICUs.
• To identify risk factors associated with HAIs in critically ill pediatric patients.

Main Methods:

• A multicenter, prospective study involving 11,260 pediatric patients across 26 Spanish PICUs from 2014 to 2019.
• Analysis compared HAI rates before (2014-2016) and after (2017-2019) the widespread adoption of HAI Zero Bundles.
• Multivariate analysis identified key risk factors for HAI acquisition.

Main Results:

• The overall HAI rate was 6.3 per 1000 patient-days, with specific rates for central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTIs).
• A significant decrease in HAI episodes (p = 0.011) and a trend towards decreased HAI rates (p = 0.061) were observed after implementing HAI Zero Bundles.
• Previous colonization by multidrug-resistant (MDR) bacteria was the most significant extrinsic risk factor for HAIs (OR 20.4).

Conclusions:

• HAI Zero Bundles effectively reduce HAI rates in PICUs.
• Prompt removal of invasive devices is critical for preventing HAIs.
• Targeting device use and addressing colonization by MDR bacteria are key strategies for HAI prevention in critically ill children.