Assessing equity in preventing central line-associated bloodstream infections and surgical site infections in pediatric patients.

Abstract

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.