Editorial note: Ms. Kim is a pediatric nurse and a 2nd year PhD student interested in nursing care quality in inpatient pediatrics. She plans to pursue a career in pediatric health services research. -Heather Tubbs-Cooley, PhD, RN, FAAN, Editorial Board Member, Pediatrics
Insertion of central venous catheters (CVCs) is a common pediatric procedure but carries a risk of central line-associated bloodstream infections (CLABSI). Central line-associated infections are largely preventable, and hospitals have made substantial progress to reduce them, but CLABSIs continue to be a major contributor to negative outcomes including morbidity, mortality, and costs related to protracted hospitalization. Racial and ethnic disparities in pediatric outcomes exist across specialties; minority children have worse outcomes than White children on a plethora of clinical metrics. Does this pattern also manifest for CLABSIs in pediatric hospitals?
This week, Pediatrics published a study by Brittany and colleagues (10.1542/peds.2021-054955) evaluating this question. Using a retrospective study design, the authors analyzed data from 226,802 children (<18 years) in 49 tertiary children’s hospitals from 2016-2021 who required CVC placement; data were obtained through the Pediatric Health Information System database.
The authors found that although CLABSI rates decreased over time for both Black and White children, Black and Hispanic children had consistently higher rates of CLABSIs compared to White children. There was no evidence that the gap in CLABSI rates between groups declined even though rates declined within groups. To wit, the rate of CLABSIs in Black and Hispanic children in the first quarter of 2021 was higher than the rate of CLABSI in White children in 2016.
These results are consistent with prior studies on racial and ethnic gaps in CLABSI rates in homecare and ambulatory environments. In pediatrics, CVC maintenance bundles are the primary method of CLABSI prevention and fall within the domain of nursing care. A recent single-institution study found an increased rate of CLABSI in Black children, as well as variation in interpreter use and CLABSI maintenance bundle practices by race and ethnicity. The authors of this study suggest that implicit bias among nurses may be a factor that contributes to variable CLABSI prevention practices and merits further exploration.
Read the article to learn more about how racial and ethnic disparities in clinical pediatric settings can impact children who need CVCs as part of their care. If you are interested in exploring and understanding pediatric health and health care disparities, it is sure to deepen and broaden your thoughts on the topic.
Second primary author: Heather Tubbs-Cooley, PhD, RN, FAAN, Editorial Board Member, Pediatrics