{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T07:17:20Z","timestamp":1782890240707,"version":"3.54.5"},"reference-count":38,"publisher":"Cambridge University Press (CUP)","issue":"11","license":[{"start":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T00:00:00Z","timestamp":1728259200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X24001119_as1\"><jats:title>Objective:<\/jats:title><jats:p>Central line-associated bloodstream infection (CLABSI) is one of the most prevalent pediatric healthcare-associated infections and is used to benchmark hospital performance. Pediatric patients have increased in acuity and complexity over time. Existing approaches to risk adjustment do not control for individual patient characteristics, which are strong predictors of CLABSI risk and vary over time. Our objective was to develop a risk adjustment model for CLABSI in hospitalized children and compare observed to expected rates over time.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X24001119_as2\"><jats:title>Design and Setting:<\/jats:title><jats:p>We conducted a prospective cohort study using electronic health record data at a quaternary Children\u2019s Hospital.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X24001119_as3\"><jats:title>Patients:<\/jats:title><jats:p>We included hospitalized children with central catheters.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X24001119_as4\"><jats:title>Methods:<\/jats:title><jats:p>Risk factors identified from published literature were considered for inclusion in multivariable modeling based on association with CLABSI risk in bivariable analysis and expert input. We calculated observed and expected (risk model-adjusted) annual CLABSI rates.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X24001119_as5\"><jats:title>Results:<\/jats:title><jats:p>Among 16,411 patients with 520,209 line days, 633 patients experienced 796 CLABSIs. The final model included age, behavioral health condition, non-English speaking, oncology service, port catheter type, catheter dwell time, lymphatic condition, total parenteral nutrition, and number of organ systems requiring ICU level care. For every organ system receiving ICU level care the odds ratio for CLABSI was 1.24 (95% CI 1.12\u20131.37). Although not statistically different, observed rates were lower than expected rates for later years.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X24001119_as6\"><jats:title>Conclusions:<\/jats:title><jats:p>Failure to adjust for patient factors, particularly acuity and complexity of disease, may miss clinically significant differences in CLABSI rates, and may lead to inaccurate interpretation of the impact of quality improvement efforts.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2024.111","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T07:36:56Z","timestamp":1728286616000},"page":"1280-1285","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Importance of risk adjusting central line-associated bloodstream infection rates in children"],"prefix":"10.1017","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6786-9523","authenticated-orcid":false,"given":"Lakshmi","family":"Srinivasan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Oliver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1942-6197","authenticated-orcid":false,"given":"Yuan-shung V","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Shu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kait M","family":"Donnelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4936-0969","authenticated-orcid":false,"given":"Cecelia","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy L.","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Keren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2024,10,7]]},"reference":[{"key":"S0899823X24001119_ref38","unstructured":"38. CMS.gov. Risk Adjustment in Quality Improvement. CMS Measures Management System (MMS) Hub; 2023. https:\/\/mmshub.cms.gov\/sites\/default\/files\/Risk-Adjustment-in-Quality-Measurement.pdf. Accessed March 15, 2023."},{"key":"S0899823X24001119_ref1","unstructured":"1. Institute of Medicine Committee on Quality of Health Care in A. In: Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building a Safer Health System. National Academies Press (US). Copyright 2000 by the National Academy of Sciences."},{"key":"S0899823X24001119_ref36","doi-asserted-by":"publisher","DOI":"10.1086\/503173"},{"key":"S0899823X24001119_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2005.08.019"},{"key":"S0899823X24001119_ref35","unstructured":"35. Lyren, A , Children\u2019s hospitals\u2019 solutions for patient safety. Personal Communication, 2023."},{"key":"S0899823X24001119_ref20","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2020.3223"},{"key":"S0899823X24001119_ref32","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.14780"},{"key":"S0899823X24001119_ref5","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-1958"},{"key":"S0899823X24001119_ref22","doi-asserted-by":"publisher","DOI":"10.1086\/656246"},{"key":"S0899823X24001119_ref37","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2021.266"},{"key":"S0899823X24001119_ref10","unstructured":"10. National Healthcare Safety Network. Bloodstream infection event (central line\u2013associated bloodstream infection and non-central line associated bloodstream infection). Updated January 2023. https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/4psc_clabscurrent.pdf. 2023. Accessed February 6, 2023."},{"key":"S0899823X24001119_ref24","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2019.302"},{"key":"S0899823X24001119_ref9","unstructured":"9. The NHSN Standardized Infection Ratio: A guide to the SIR. 2022. https:\/\/www.cdc.gov\/nhsn\/pdfs\/ps-analysis-resources\/nhsn-sir-guide.pdf. Accessed February 1, 2023."},{"key":"S0899823X24001119_ref27","doi-asserted-by":"publisher","DOI":"10.1007\/s13312-016-0932-y"},{"key":"S0899823X24001119_ref14","unstructured":"14. Srinivasan, L , Padula, M , on behalf of the Infectious Diseases Focus Group of the Children\u2019s Hospital Neonatal Consortium. Disease-specific Blood Stream Infection and CLABSI Rates among Infants in Level 4 CHNC NICUs. Platform presentation at the Children\u2019s Hospital Neonatal Consortium Annual Conference, Denver, CO. 2022."},{"key":"S0899823X24001119_ref25","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000001835"},{"key":"S0899823X24001119_ref28","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-054955"},{"key":"S0899823X24001119_ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2022.05.005"},{"key":"S0899823X24001119_ref4","unstructured":"4. Agency for Healthcare Research and Quality. Eliminating CLABSI, A National Patient Safety Imperative: Final Report. 2013. https:\/\/www.ahrq.gov\/hai\/cusp\/clabsi-final\/index.html. Accessed March 15, 2023."},{"key":"S0899823X24001119_ref13","doi-asserted-by":"publisher","DOI":"10.1177\/1536867X0700700205"},{"key":"S0899823X24001119_ref31","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2018.10"},{"key":"S0899823X24001119_ref19","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2017.188"},{"key":"S0899823X24001119_ref8","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3795"},{"key":"S0899823X24001119_ref7","unstructured":"7. Agency for Healthcare Research and Quality. Pediatric Quality Indicators (PDI) Benchmark Data Tables, v2022. 2022. https:\/\/qualityindicators.ahrq.gov\/downloads\/modules\/PDI\/V2022\/Version_2022_Benchmark_Tables_PDI.pdf. 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Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}