Hostname: page-component-669899f699-7tmb6 Total loading time: 0 Render date: 2025-04-29T20:06:19.275Z Has data issue: false hasContentIssue false
  • English
  • Français

Racial and ethnic disparities in central line-associated bloodstream infections (CLABSI) in hospitalized patients: a risk-adjusted analysis

Published online by Cambridge University Press:  18 February 2025

Sandeep Tripathi Open the ORCID record for Sandeep Tripathi [Opens in a new window] ,
Taylor Walter Open the ORCID record for Taylor Walter [Opens in a new window]  and
Jeremy McGarvey Open the ORCID record for Jeremy McGarvey [Opens in a new window]
Sandeep Tripathi*
Affiliation:
Division of Pediatric Intensive Care, Department of Pediatrics, Children’s Hospital of Illinois at OSF HealthCare, Peoria, IL, USA University of Illinois College of Medicine at Peoria, Peoria, IL, USA
Taylor Walter
Affiliation:
Ministry Healthcare Analytics, OSF HealthCare, Peoria, IL, USA
Jeremy McGarvey
Affiliation:
Ministry Healthcare Analytics, OSF HealthCare, Peoria, IL, USA
*
Corresponding author: Sandeep Tripathi; Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To compare the risk and exposure-adjusted central line-associated bloodstream infection (CLABSI) rates between racial and ethnic groups.

Design:

Retrospective cohort study.

Setting:

15 network hospitals in Illinois and Michigan (Part of OSF HealthCare).

Patients:

Patients of all age groups who had a central line inserted and removed during the same hospitalization between 01/2018 and 06/2023.

Methods:

CLABSI rates/1000 Central line days of the four major racial and ethnic categories (Hispanic, non-Hispanic White [NHW], non-Hispanic Black [NHB], and non-Hispanic others) were analyzed by generalized Poisson regression. Confounding variables included in the regression model based on a directed acyclic graph and included age group, insurance class, language, ICU admission, diagnostic cohorts (obesity, diabetes, dialysis, cancer, neutropenia), and line usage (blood products, chemotherapy, total parenteral nutrition).

Results:

27,674 central lines (244,889 catheter days) on 23,133 unique patients (median age 64 years, 8% pediatric patients) were included in the analysis. Overall, the CLABSI rate was 1.070/1000 Central line days. 76% of the study population was NHW, 17% NHB, and 4% Hispanic. After adjusting for confounding variables, Hispanic patients had higher CLABSI rates than NHW (IRR 1.89, 95% CI 1.15–3.10, P = .013). No significant difference was observed in the CLABSI rates between NHW and NHB patients.

Conclusion:

Disparities in hospital-associated conditions persist even after controlling for patient-level risk factors and exposures, with Hispanic patients at the highest risk.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 46 , Issue 4 , April 2025 , pp. 356 - 362
Check for updates
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Previous Submission: The abstract from this data has been accepted for presentation at the Society of Critical Care Medicine National Congress, which will be held in February 2025. It will be published in the Critical Care Medicine supplement for Congress abstracts.

References

Institute of Medicine. Unequal Treatment. Washington (DC): National Academies Press; 2002.Google Scholar
Lyren, A, Haines, E, Fanta, M, et al. Racial and ethnic disparities in common inpatient safety outcomes in a children’s hospital cohort. BMJ Qual Saf 2024;33:86–97.CrossRefGoogle Scholar
Shen, JJ, Cochran, CR, Mazurenko, O, et al. Racial and insurance status disparities in patient safety indicators among hospitalized patients. Ethnicity Dis 2016;26:443.CrossRefGoogle ScholarPubMed
Willer, BL, Tobias, JD, Suttle, ML, Nafiu, OO, Mpody, C. Trends of racial/ethnic disparities in pediatric central line–associated bloodstream infections. Pediatr 2022;150:e2021054955.CrossRefGoogle ScholarPubMed
Stockwell, DC, Landrigan, CP, Toomey, SL, et al. Racial, ethnic, and socioeconomic disparities in patient safety events for hospitalized children. Hosp Pediatr 2019;9:1–5.CrossRefGoogle ScholarPubMed
Khan, A, Yin, HS, Brach, C, et al. Association between parent comfort with English and adverse events among hospitalized children. JAMA Pediatr 2020;174:e203215–e203215.CrossRefGoogle ScholarPubMed
Moriyama, K, Ando, T, Kotani, M, et al. Risk factors associated with increased incidences of catheter-related bloodstream infection. Med 2022;101:e31160.CrossRefGoogle ScholarPubMed
Martinez, J, Santo, A, Godinho, A, et al. Acute leukemia patients: a CLABSI risk special population. Ann Hematol Oncol 2018;5:1192.Google Scholar
Lafuente Cabrero, E, Terradas Robledo, R, Civit Cuñado, A, et al. Risk factors of catheter- associated bloodstream infection: systematic review and meta-analysis. PloS One 2023;18:e0282290.CrossRefGoogle ScholarPubMed
AHRQ. 2021 National Healthcare Quality and Disparities Report. Rockville, MD: AHRQ; 2021.Google Scholar
OSF Health Care. Facts and Figures. https://x.osfhealthcare.org/patients-visitors/about/facts-figures. Published 2024. Accessed September 9, 2024.Google Scholar
National Healthcare Safety Network (NSHN). Bloodstream Infection (BSI) Events. U.S Department of Health &Human Services. https://www.cdc.gov/nhsn/psc/bsi/index.html. Published 2024. Accessed September 17, 2024.Google Scholar
Office of Management and Budget Standards. Revisions to the standards for the classification of federal data on race and ethnicity. Fed Regist 1997;62:58782–58790.Google Scholar
CDC. CDC COVID Data Tracker. Atlanta, GA: Centers for Disease Control and Prevention; 2025.Google Scholar
Textor, J, Van der Zander, B, Gilthorpe, MS, Liśkiewicz, M, Ellison, GT. Robust causal inference using directed acyclic graphs: the R package ‘dagitty’. Int J Epidemiol 2016;45:1887–1894.Google ScholarPubMed
Williams, TC, Bach, CC, Matthiesen, NB, Henriksen, TB, Gagliardi, L. Directed acyclic graphs: a tool for causal studies in paediatrics. Pediatr Res 2018;84(4):487–493.CrossRefGoogle ScholarPubMed
R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2021.Google Scholar
Gottlieb, LB, Prakash-Asrani, R, Dube, W, Wiley, Z, Licitra, G, Fridkin, SK. Assessing for race, ethnicity, and socioeconomic disparities in central line-associated bloodstream infection risk in a large academic health system. Infect Control Hosp Epidemiol 2024;45:1–6.CrossRefGoogle Scholar
Bakullari, A, Metersky, ML, Wang, Y, et al. Racial and ethnic disparities in healthcare-associated infections in the United States, 2009–2011. Infect Control Hosp Epidemiol 2014;35:S10–S16.CrossRefGoogle ScholarPubMed
Ziegler, MJ, Pellegrini, DC, Safdar, N. Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infect 2015;43:29–36.CrossRefGoogle ScholarPubMed
Stevens, V, Geiger, K, Concannon, C, Nelson, RE, Brown, J, Dumyati, G. Inpatient costs, mortality and 30-day re-admission in patients with central-line-associated bloodstream infections. Clin Microbiol Infect 2014;20:O318–O324.CrossRefGoogle ScholarPubMed
Di Gangi, A, Pini, CM, Baccelli, F, et al. The importance of patients and caregivers education to prevent central line associated bloodstream infections in children with malignancies: a single center experience. Blood 2018;132:5866–5866.CrossRefGoogle Scholar
Tripathi, S, McGarvey, J, Lee, K, et al. Compliance with central line maintenance bundle and infection rates. Pediatr 2023;152:e2022059688.CrossRefGoogle ScholarPubMed
Borg, MA. Cultural determinants of infection control behaviour: understanding drivers and implementing effective change. J Hosp Infect 2014;86:161–168.CrossRefGoogle ScholarPubMed
Jongen, C, McCalman, J, Bainbridge, R. Health workforce cultural competency interventions: a systematic scoping review. BMC Health Serv Res 2018;18:232.CrossRefGoogle Scholar
McGrath, CL, Bettinger, B, Stimpson, M, et al. Identifying and mitigating disparities in central line–associated bloodstream infections in minoritized racial, ethnic, and language groups. JAMA Pediatr 2023;177:700–709.CrossRefGoogle ScholarPubMed
Supplementary material: File

Tripathi et al. supplementary material 1

Tripathi et al. supplementary material
Download Tripathi et al. supplementary material 1(File)
File 16.5 KB
Supplementary material: File

Tripathi et al. supplementary material 2

Tripathi et al. supplementary material
Download Tripathi et al. supplementary material 2(File)
File 14.9 KB
Supplementary material: File

Tripathi et al. supplementary material 3

Tripathi et al. supplementary material
Download Tripathi et al. supplementary material 3(File)
File 17.4 KB
Supplementary material: File

Tripathi et al. supplementary material 4

Tripathi et al. supplementary material
Download Tripathi et al. supplementary material 4(File)
File 13.9 KB
Supplementary material: File

Tripathi et al. supplementary material 5

Tripathi et al. supplementary material
Download Tripathi et al. supplementary material 5(File)
File 28.4 KB
Supplementary material: File

Tripathi et al. supplementary material 6

Tripathi et al. supplementary material
Download Tripathi et al. supplementary material 6(File)
File 27.7 KB
Supplementary material: File

Tripathi et al. supplementary material 7

Tripathi et al. supplementary material
Download Tripathi et al. supplementary material 7(File)
File 14.8 KB