Purpose: Adherence to full sterile procedures may be compromised when central venous catheters are inserted as part of emergency resuscitation and stabilisation, particularly outside the intensive care unit. Half of emergency admissions to paediatric intensive care units (PICU) in the UK occur after stabilisation at other hospitals. We determined whether bloodstream infection (BSI) occurred more frequently in children admitted to PICU after inter-hospital transfer compared to within-hospital admissions.
Methods: Data on emergency admissions to 20 PICUs in England and Wales for children <16 years between 2003–2012 were linked from the national PICU audit database (PICANet) and national infection surveillance (LabBase2). PICU-acquired BSI was defined as any positive blood culture sampled between 2 days after admission and 2 days following discharge from PICU.
Results: A total of 32,861/62,515 (53 %) admissions were inter-hospital transfers. Multivariable regression showed no significant difference in rates of PICU-acquired BSI by source of admission (incidence-rate ratio for inter-hospital transfer versus within-hospital admission = 0.97; 95 % CI 0.87–1.07) after adjusting for other risk-factors. Rates decreased more rapidly between 2003 and 2012 for inter-hospital transfers: 17.0 % (95 % CI 14.9–19.0 % per year) compared with 12.4 % (95 % CI 9.9–14.9 % per year) for within-hospital admissions. The median time to first PICU-acquired BSI did not differ significantly between inter-hospital transfers (7 days; IQR 4–13) and within-hospital admissions (8 days; IQR 4–15).
Conclusions: Nationally, inter-hospital transfer is no longer a significant risk factor for PICU-acquired BSI. Given the large proportion of infection occurring in the second week of admission, initiatives to further reduce PICU-acquired BSI should focus on maintaining sterile procedures after admission.
Bibliographical noteFunding Information:
Acknowledgments The authors would like to acknowledge Angie Wade and Harvey Goldstein who made substantial contributions to the original data linkage study. The authors would also like to thank Tom Fleming, Phil McShane and Lee Norman (PICANet) for facilitation of data retrieval for this paper. We would like to thank all the staff in participating hospitals who have collected data for PICANet. We are grateful to the UK Paediatric Intensive Care Society for continued support and to the members of the PICANet Steering Group and Clinical Advisory Group who are listed on our website http://www.picanet.org.uk/participants.html. This work was supported by funding for the CATCH trial from the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number 08/13/47). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health. Ruth Gilbert is supported by awards establishing the Farr Institute of Health Informatics Research at UCLP Partners from the MRC and a consortium of funders (MR/K006584/1). PICANet is funded by the National Clinical Audit & Patient Outcomes Programme, administered by the Healthcare Quality Improvement Partnership (HQIP); Welsh Health Specialised Services Committee; NHS Lothian/National Service Division NHS Scotland; the Royal Belfast Hospital for Sick Children; National Office of Clinical Audit Ireland (NOCA) and HCA International.
© 2014, The Author(s).
- Bloodstream infection
- Data linkage
- Infection control
- Paediatric intensive care
- Risk factors