403 - Language Equity Directed Care Bundle Reduces Disparities in Pediatric Central Line Associated Blood Stream Infections in Pediatric Patients

Publication Number: 403.5977

Elizabeth J. Haines, NYU, New York, NY, United States; Rebecca Malizia, Hassenfeld Children’s Hospital at NYU Langone, New York, NY, United States; Patrick Yam, Hassenfeld Children's Hospital at NYU Langone, Brooklyn, NY, United States; Wenhao Li, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States

Background: Health disparities in children are often studied for clinical conditions such as asthma or cardiac disease. In 2020, our hospital began to observe race, ethnicity, and language stratified outcome measures of in-hospital acquired preventable harm, including central line associated blood stream infections (CLABSIs). CLABSIs contribute to increased mortality, morbidity, and hospital stays for pediatric patients. Baseline data from our academic children’s hospital CY2020-21 identified that children with chart-identified language preferences other than English (LOE) were 1.62 times more likely to experience a hospital-acquired CLABSI relative to children who had a language preference of English (ELP).

Objective: To assess the impact of an equity care bundle on a reduction of safety disparities.

Design/Methods: To address this baseline outcome disparity in CLABSI rates, we designed an equity-targeting intervention bundle that would be delivered to patients twice weekly via structured rounds. The care bundle included: 1) interpretation utilization 2) discussion and translated education outlining a) daily actions medical professionals take to prevent infection and b) patient and family actions to prevent infections 3) opportunity to address questions 4) performance of a static audit to assess the line for any non-compliance to hygiene bundles. Initiation of language equity rounding and bundles began 12/2022. Process measures tracked included compliance rates of LOE patients with a central line who had an equity bundle completed. Summary statistics were performed to describe the odds ratios of inpatient CLABSI rates between two language populations, comparing 2020-21 data to 2022-23.

Results: In CY2022-23 there were 5563 LOE central line days and 5 CLABSIs in LOE patients (mean LOE rate 0.9/1000 device days). In CY2022-2023 there were 16326 ELP central line days and 11 CLABSIs (mean ELP rate 0.67 per 1000 device days). The odds ratio of LOE patients acquiring a CLABSI reduced from 1.62 in 2020-21 to 1.34 in 2022-23. Though post implementation trends demonstrated directional improvement, this did not reach statistical significance as the relative frequency of CLABSI is exceedingly rare ( < 1 /1000 device days), therefore we will need to obtain additional years of data, both retrospectively and prospectively, to demonstrate statistical significance in the reduced odds of infection among LOE patients.

Conclusion(s): Equity-based bundles may serve as a solution to reducing disparities in care processes that translate to differences in safety outcomes for hospitalized children. Ongoing analysis will be necessary.

Table 1: Patient Characteristics and Infection Rates
Comparison of Infection Rates Pre-Post Deployment of Equity Based Rounding and Bundles

Figure 1: Equity Bundle Compliance Rates
Process_measure_equityQI_PAS.pdfDepicts Monthly Percent Compliance of all Patients with Language Preferences Other than English (LOE) and a Central Line Who Received an Equity Bundle During their Inpatient Encounter