PHHP 18 - Risk Factors for Central Line-associated Bloodstream Infection in a NICU Population: Experiences at a Pediatric Hospital in South Texas

Background: Central line-associated bloodstream infection (CLABSI) causes significant harm in patient populations, especially neonatal intensive care unit (NICU) patients. In this population, it is the most common nosocomial infection, leading to significant morbidity and mortality. However, data regarding CLABSI risk factors and prevention strategies in NICU patients is limited.

Methods: A retrospective cohort study was conducted in the NICU at a pediatric hospital in South Texas. Detailed records of central line insertions (central line type, number of lumens, placement site, date of placement and removal) occurring in NICU patients from January 2018 to early November 2022 (N = 1,356) were extracted from the electronic medical record, along with risk factors of CLABSI (length of stay, gestational age, age at line placement, birthweight, any surgery, and receipt of parenteral nutrition and blood products). Central line insertions associated with CLABSI (N = 35) were compared to instances without CLABSI (N = 1,321) in a univariate (X2 and student’s t-tests) and multivariate (logistic regression) analysis.

Results: Univariate risk factors (p ≤ .05) were: very low birth weight, receipt of blood products, implantable central lines, neck site placement, longer device dwell time, age at line placement, and days patient was admitted before line placement. Multivariate risk factors were: very low birth weight and days admitted before line placement (p ≤ .10), as well as years 2021 and 2022, and implantable device (p ≤ .05). Implantable device had the largest effect size (Standardized β = 4.78), indicating they explain more of the variance in CLABSI than every other variable.

Conclusions: Implantable central lines are an independent risk factor for CLABSI in a NICU population at this facility, explaining more of the variance in this outcome than known predictors. Years 2021 and 2022 are also notable predictors of CLABSI, which warrants further investigation.