title: Risk-adjusted monitoring of blood-stream infection in paediatric intensive care: a data linkage study.
abstract: OBJECTIVE
  National monitoring of variation in the quality of infection control in paediatric intensive care units (PICUs) requires comparisons of risk-adjusted rates. To inform the development of a national monitoring system, we evaluated the effects of risk-adjustment and outcome definition on comparisons of blood-stream infection (BSI) rates in PICU, using linkage of risk-factor data captured by national audit (PICANet) with laboratory records of BSI.
  
  
  METHODS
  Admission data for two children's hospitals 2003-2010 were extracted from PICANet and linked using multiple identifiers with laboratory BSI records. We calculated trends of PICU-acquired BSI, defined as BSI occurring between at least 2 days after admission until up to 2 days following discharge. In one PICU, we compared rates of all PICU-acquired BSI with clinically significant PICU-acquired BSI submitted to the national surveillance system.
  
  
  RESULTS
  Of 20,924 admissions, 1,428 (6.8 %) were linked to 1,761 PICU-acquired BSI episodes. The crude incidence rate-ratio for PICU-acquired BSI between PICUs was 1.15 [95 % confidence interval (CI) 1.05-1.26] but increased to 1.26 (1.14-1.39) after risk-adjustment. Rates of PICU-acquired BSI were 13.44 (95 % CI 12.60-14.28) per 1,000 bed-days at PICU 1 and 18.05 (95 % CI 16.80-19.32) at PICU 2. Of PICU-acquired BSI at PICU 2, 41 % was classified as clinically significant. Rates of PICU-acquired BSI decreased by 10 % per year between 2003 and 2010 for skin organisms and 8 % for non-skin organisms.
  
  
  CONCLUSIONS
  Risk-adjustment and standardisation of outcome measures are essential for fair comparisons of BSI rates between PICUs. Linkage of risk-factor data and BSI surveillance is feasible and could allow national risk-adjusted monitoring.
authors: MRC Centre for Epidemiology of Child Health, Institute of Child Health, University College London, 30 Guilford Street, London WC1 N 1EH, UK. k.harron@ich.ucl.ac.uk
authors: Katie
authors: K
authors: Harron
authors: Angie
authors: A
authors: Wade
authors: Berit
authors: B
authors: Muller-Pebody
authors: Harvey
authors: H
authors: Goldstein
authors: Roger
authors: R
authors: Parslow
authors: Jim
authors: J
authors: Gray
authors: John C
authors: JC
authors: Hartley
authors: Quen
authors: Q
authors: Mok
authors: Ruth
authors: R
authors: Gilbert
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D015278:Intensive Care Units, Pediatric; D008297:Male; D011159:Population Surveillance; D011785:Quality Assurance, Health Care; D020379:Risk Adjustment / Q000379:methods*; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
references: Pediatrics. 2002 Sep;110(3):481-5
references: 12205248
references: Intensive Care Med. 2004 Jan;30(1):62-7
references: 14647886
references: J Infect. 2011 Feb;62(2):130-5
references: 21195110
references: J Trop Pediatr. 2007 Apr;53(2):87-92
references: 17151083
references: Br J Surg. 2010 May;97(5):772-81
references: 20306528
references: Pediatr Infect Dis J. 2009 Feb;28(2):114-7
references: 19116605
references: Am J Infect Control. 2008 Jun;36(5):309-32
references: 18538699
references: J Clin Epidemiol. 2006 Sep;59(9):940-6
references: 16895817
references: Intensive Care Med. 2011 Oct;37(10):1641-7
references: 21877212
references: BMJ. 2007 Feb 17;334(7589):362-5
references: 17303886
references: J Hosp Infect. 2011 Jan;77(1):16-20
references: 21030112
references: Pediatrics. 2010 Feb;125(2):206-13
references: 20064860
references: BMJ. 2008 Oct 06;337:a1714
references: 18838424
references: J Clin Epidemiol. 2005 Oct;58(10):1006-14
references: 16168346
references: Lancet. 2004 Apr 3;363(9415):1147-54
references: 15064036
references: Pediatr Cardiol. 2010 May;31(4):483-9
references: 20063161
references: Pediatrics. 2005 Apr;115(4):868-72
references: 15805357
references: Intensive Care Med. 2003 Feb;29(2):278-85
references: 12541154
references: J Hosp Infect. 2011 Nov;79(3):231-5
references: 21868128
references: Intensive Care Med. 1997 Feb;23(2):201-7
references: 9069007
references: BMJ. 1996 Jun 15;312(7045):1503-5
references: 8646140
references: BMJ. 2010 Feb 04;340:c309
references: 20133365
references: Med Care. 2005 Nov;43(11):1130-9
references: 16224307