P2.N270: CLABSI Risk “Beyond the Bundle”

Purpose/Objectives: The attributable mortality of central line-associated bloodstream infections (CLABSI) is 10-20%, in addition to baseline mortality risk. The attributable cost of CLABSI is roughly $55,000. Adherence to prevention bundles is shown to decrease CLABSI rates. Our goal was to identify non-traditional risk factors for CLABSI in pediatric inpatients.

Design/Methods: We performed a common cause analysis on pediatric CLABSIs January 2020- December 2022 using electronic health records and data submitted to the Centers for Disease Control and Prevention National Healthcare Safety Network (NHSN). CLABSI rate [# CLABSI / total central venous catheter (CVC) days] was calculated for CVC characteristics including CVC type, number of concurrent CVCs, patient language, CVC securement type, lumen count, location, and duration of placement. A total of 3,672 CVCs were used in analysis. We utilized NHSN definition criteria (excluding CVC days and CLABSI involving right atrial, umbilical arterial catheters, etc.).

Results: In our analysis of 51,752 CVC days and 73 CLABSIs over 3 years, CLABSI rate for patients with a single CVC was 0.90/1000 CVC days vs. 4.29 in patients with multiple CVCs. Having multiple CVCs carries a higher risk than does the same number of lumens using a single CVC. CLABSI rate for single CVCs secured with securement device was higher than single CVCs secured with sutures (1.34 vs 0.93/1000 CVC days). CLABSI risk was higher in non-English speaking patients (2.23 vs 1.37/1000 CVC days).  CLABSI risk was lower in patients with a single CVC placed in the femoral vein vs basilic or internal jugular vein (0.22 vs 1.64 vs 1.07/100 CBC days).

Conclusion/Discussion: Adult literature demonstrates use of securement devices reduce and femoral lines increase CLABSI risk. However, our pediatric data suggest otherwise, calling for future research investigating non-traditional CLABSI risk factors in pediatric patients. Highlighting a preoccupation with failure approach, we “HAC huddle” with care teams and families on high-risk patients at least weekly. We will utilize data from this project to inform “beyond the bundle” practices and HAC huddles with those who have increased non-traditional risk of CLABSI. Our education efforts also need to be revised to ensure language is not a barrier to CLABSI reduction.