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. 2022 Oct 31;9(11):1669.
doi: 10.3390/children9111669.

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

Elena Fresán-Ruiz  1   2 , Gemma Pons-Tomás  3 , Juan Carlos de Carlos-Vicente  4 , Amaya Bustinza-Arriortua  5 , María Slocker-Barrio  5 , Sylvia Belda-Hofheinz  6 , Montserrat Nieto-Moro  7 , Sonia María Uriona-Tuma  8 , Laia Pinós-Tella  8 , Elvira Morteruel-Arizcuren  9 , Cristina Schuffelmann  10 , Yolanda Peña-López  11 , Sara Bobillo-Pérez  1   2 , Iolanda Jordan  1   12 , On Behalf Of The Pediatric-Envin-Helics Study Group
Affiliations

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

Elena Fresán-Ruiz et al. Children (Basel). .

Abstract

Healthcare-associated infections related to device use (DA-HAIs) are a serious public health problem since they increase mortality, length of hospital stay and healthcare costs. We performed a multicenter, prospective study analyzing critically ill pediatric patients admitted to 26 Spanish pediatric intensive care units (PICUs) over a 3-month period each year from 2014 to 2019. To make comparisons and evaluate the influence of HAI Zero Bundles (care bundles that intend to reduce the DA-HAI rates to zero) on PICU HAI rates, the analysis was divided into two periods: 2014-2016 and 2017-2019 (once most of the units had incorporated all the Zero Bundles). A total of 11,260 pediatric patients were included. There were 390 episodes of HAIs in 317 patients and the overall rate of HAIs was 6.3 per 1000 patient days. The DA-HAI distribution was: 2.46/1000 CVC days for central-line-associated bloodstream infections (CLABSIs), 5.75/1000 MV days for ventilator-associated pneumonia (VAP) and 3.6/1000 UC days for catheter-associated urinary tract infections (CAUTIs). Comparing the two periods, the HAI rate decreased (p = 0.061) as well as HAI episodes (p = 0.011). The results demonstrate that exposure to devices constitutes an extrinsic risk factor for acquiring HAIs. The multivariate analysis highlights previous bacterial colonization by multidrug-resistant (MDR) bacteria as the most important extrinsic risk factor for HAIs (OR 20.4; 95%CI 14.3-29.1). In conclusion, HAI Zero Bundles have been shown to decrease HAI rates, and the focus should be on the prompt removal of devices, especially in children with important intrinsic risk factors.

Keywords: CAUTI; CLABSI; HAI Zero Bundles; HAI risk factors; PICU; Spain; VAP; children; device-associated infections; healthcare-associated infections.

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Conflict of interest statement

The authors declare no conflict of interest. The funding entities had no role in the design of the study; the collection, analysis or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Device utilization ratio and device-associated infections. CAUTIs: catheter-associated urinary tract infections; CLABSIs: central-line-associated blood stream infections; CVC: central venous catheter; UC: urinary catheter; VAP: ventilator-associated pneumonia.
Figure 2
Figure 2
The cumulative incidence for each healthcare-associated infection per year. CAUTIs: catheter-associated urinary tract infections; CLABSIs: central-line-associated blood stream infections; USB: unknown-source bacteremia; VAP: ventilator-associated pneumonia.
Figure 3
Figure 3
The cumulative incidence for each healthcare-associated infection per year, according to age. CAUTIs: catheter-associated urinary tract infections; CLABSIs: central-line-associated blood stream infections; USB: unknown-source bacteremia; VAP: ventilator-associated pneumonia.
Figure 4
Figure 4
Forest plot representing the independent intrinsic risk factors for healthcare-associated infections. PICU: pediatric intensive care unit. PRISM III: Pediatric Risk of Mortality score.
Figure 5
Figure 5
Correlation analysis for device exposure.
See this image and copyright information in PMC

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