Healthcare-Acquired Infections Fall in Critically Ill Kids

Laurie Barclay, MD

September 08, 2014

Between 2007 and 2012, central line-associated bloodstream infections (CLABSIs) and ventilator-assisted pneumonias declined significantly in critically ill children, according to a national cohort study. However, no change was seen in the rate of catheter-associated urinary tract infections (CAUTIs), the investigators report in an article published online September 8 in Pediatrics.

The investigators conclude that national efforts to improve patient safety by decreasing healthcare-acquired infections (HAIs) have been effective and must continue.

HAIs are associated with longer hospital stays, increased cost, longer ventilation times, and worse neurodevelopmental outcomes in children, according to Stephen W. Patrick, MD, MPH, from the Department of Pediatrics and the Mildred Stahlman Division of Neonatology, Vanderbilt University, and the Vanderbilt Center for Health Services Research, Nashville, Tennessee, and colleagues. Yet HAIs are common, with some estimates suggesting more than 1 in 5 critically ill children are affected, and nationwide data are limited.

Therefore, the investigators analyzed trends for 3 of the most common HAIs: CLABSI, ventilator-associated pneumonia, and CAUTI. The study cohort included patients admitted to 173 neonatal intensive care units (NICUs) and 64 pediatric intensive care units (PICUs) at hospitals reporting HAI data to the National Healthcare Safety Network at the Centers for Disease Control and Prevention.

During the study period, rates of CLABSIs in NICUs declined 61%, going from 4.9 to 1.5 per 1000 central-line days. The incidence rate ratio (IRR) per quarter was 0.96 (95% confidence interval [CI], 0.94 - 0.97). In PICUs, CLABSIs decreased from 4.7 to 1.0 per 1000 central line days (IRR per quarter, 0.96; 95% CI, 0.94 - 0.98).

"In addition to improving important patient outcomes, we estimate the reduction in CLABSI among hospitals in our sample resulted in savings of $131 million (∼$61 million in NICUs; ∼$70 million for PICUs) to these hospitals during our study period," the authors write.

The rates of ventilator-associated pneumonias in NICUs fell by 62%, going from 1.6 to 0.6 per 1000 ventilator days (IRR per quarter, 0.97; 95% CI, 0.93 - 0.99). In PICUs, the corresponding drop was from 1.9 to 0.7 per 1000 ventilator-days (IRR per quarter, 0.95; 95% CI, 0.92 - 0.98).

In contrast, there was no significant change in rates of CAUTIs. The authors note that the lack of change in CAUTI incidence may be in part because the surveillance definition has changed, making comparisons difficult. In addition, this type of HAI has not received as much attention as CLABSIs and ventilator-related pneumonia have.

Limitations of this study include a potential lack of generalizability to other US hospitals and to other types of pediatric care, as well as a change in the surveillance definition for urinary tract infection during the study period.

"Over the past several years, US hospitals made substantial improvements in preventing harm to hospitalized neonates and children by reducing HAIs," the authors write. "HAI incidence rates fell dramatically among neonates of all birth weights and among children, reducing their risk of morbidity and mortality. Eliminating HAIs must remain a prominent quality improvement goal to protect our most vulnerable patients."

This work was supported by the Agency for Healthcare Research and Quality. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online September 8, 2014.

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