title: Risk of bloodstream infection in children admitted to paediatric intensive care units in England and Wales following emergency inter-hospital transfer.
abstract: OBJECTIVE
  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.
authors.affiliation: UCL Institute of Child Health, 30 Guilford Street, WC1 N 1EH, London, UK, k.harron@ucl.ac.uk.
authors.forename: Katie
authors.initials: K
authors.lastname: Harron
authors.forename: Quen
authors.initials: Q
authors.lastname: Mok
authors.forename: Roger
authors.initials: R
authors.lastname: Parslow
authors.forename: Berit
authors.initials: B
authors.lastname: Muller-Pebody
authors.forename: Ruth
authors.initials: R
authors.lastname: Gilbert
authors.forename: Padmanabhan
authors.initials: P
authors.lastname: Ramnarayan
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D001499:Bayes Theorem; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000209:etiology; D062905:Central Venous Catheters / Q000009:adverse effects / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000639:trends; D004632:Emergency Medical Services / Q000706:statistics & numerical data* / Q000639:trends; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000639:trends; D007297:Inpatients / Q000706:statistics & numerical data; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data* / Q000639:trends; D012307:Risk Factors; D014852:Wales / Q000453:epidemiology