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Assessing equity in preventing central line-associated bloodstream infections and surgical site infections in
Xiaoyan Song1,2, Deena Levey1, Jenhao Jacob Cheng3
1Office of Infection Control/Epidemiology, Children's National Hospital, Washington, DC, USA.
Insights
Healthcare-associated infections like CLABSIs and SSIs can be prevented. This study found equity in preventing central line-associated bloodstream infections but identified disparities in surgical site infections among pediatric patients.
Area of Science:
- Healthcare epidemiology
- Infection prevention and control
- Pediatric patient safety
Background:
- Central line-associated bloodstream infections (CLABSIs) and surgical site infections (SSIs) are significant healthcare-associated infections.
- Consistent application of evidence-based practices is crucial for preventing CLABSIs and SSIs.
Purpose of the Study:
- To evaluate equity in preventing CLABSIs and SSIs in pediatric patients.
- To assess infection rates across racial, ethnic, and gender groups at a pediatric hospital.
Main Methods:
- Observational study of pediatric patients (<18 years) from 2016-2022.
- Analyzed CLABSI rates per 1000 central line days and SSI rates per 100 surgeries.
- Compared infection rates across demographic groups, including a nested case-control study for SSIs.
Main Results:
- No significant difference in CLABSI rates across racial, ethnic, or gender groups.
- SSI rates were higher in multiracial and Asian pediatric patients compared to Caucasian and Black patients.
- A nested case-control study indicated a higher SSI risk in Asian pediatric patients compared to Caucasian patients.
Conclusions:
- Standardized central line care promotes equity in CLABSI prevention.
- Further research is needed to address disparities and improve equity in SSI prevention among pediatric populations.
Background:
Central line-associated bloodstream infections (CLABSIs) and surgical site infections (SSIs) are major healthcare-associated infections that can be prevented by consistently applying evidence-based infection prevention practices.
Objective:
To assess equity in preventing CLABSIs and SSIs in pediatric patients at a free-standing pediatric hospital, where evidence-based infection prevention practices are consistently implemented.
Methods:
This observational study evaluated 2 cohorts of pediatric patients under 18 years. The CLABSI cohort included inpatients with a central line between 1/1/2016 and 12/31/2022, and the SSI cohort included patients undergoing colon, ventricular shunt, or spinal fusion surgeries between 1/1/2016 and 10/31/2022. The CLABSI rate per 1000 central line days and SSI rate per 100 surgeries were compared across different racial, ethnic, and gender groups.
Results:
In the CLABSI cohort of 8575 patients, encompassing 243,803 central line days, there were 156 CLABSIs. There was no statistical difference in CLABSI rate across race, ethnicity, and/or gender groups. The SSI cohort included 68 SSIs among 1710 patients who underwent 2230 procedures, including 714 colon, 749 ventricular shunt, and 767 spinal fusion procedures. The SSI rate was statistically higher in multiracial (9.9) and Asian (8.6) groups, compared to Caucasian (2.4) and Black (2.2) groups. A nested case-control study of the SSI cohort showed a higher SSI rate in Asians, compared to Caucasians (Odds Ratio: 3.3; 95% CI: 1.3-8.3).
Conclusions:
Equity in preventing CLABSIs is achievable through standardized central-line care. Further study is warranted to assess if improvement opportunities exist for achieving equity in preventing SSIs.
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