Facility Factors Associated With Candida Central Line-Associated Bloodstream Infections in Neonatal Intensive Care...

Area of Science:

• Neonatal Intensive Care Unit (NICU) Infections
• Healthcare-Associated Infections
• Infection Prevention and Control

Background:

• Candida species are a major cause of central line-associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs).
• CLABSIs in neonates are associated with significant morbidity and mortality.
• Limited data exist on facility-level factors influencing Candida CLABSI incidence in NICUs.

Purpose of the Study:

• To investigate facility characteristics associated with Candida CLABSI incidence in US NICUs.
• To identify specific NICU factors that may increase the risk of Candida CLABSIs.

Main Methods:

• Analysis of Candida CLABSIs reported to the National Healthcare Surveillance Network (NHSN) from 2015-2022.
• Assessment of facility characteristics using NHSN and American Hospital Association surveys.
• Negative binomial models used to evaluate associations between NICU characteristics and CLABSI incidence.

Main Results:

• Facilities with lower nurse-to-bed ratios and fewer infection preventionist hours showed increased Candida CLABSI incidence.
• Smaller NICUs, those with fewer annual neonatal admissions, and higher percentages of very low birthweight admissions had higher CLABSI rates.
• Incidence rate ratios indicated significant associations between these factors and higher Candida CLABSI rates.

Conclusions:

• Smaller NICUs and those with lower staffing levels are associated with higher Candida CLABSI rates.
• These findings suggest potential deficits in infection prevention and control capacity at these facilities.
• Data can inform facility- or system-level interventions to reduce CLABSIs and protect high-risk neonates.