Paeds · infectious-diseases
Device-associated and healthcare-associated infection
Also known as Device-associated infection · Healthcare-associated infection · CLABSI · CAUTI · Ventilator-associated pneumonia · Hospital-acquired infection
A fellowship approach to device-associated and healthcare-associated infection in children, covering NHSN surveillance definitions (CLABSI, CAUTI, ventilator-associated events), Clostridioides difficile and surgical-site infection, biofilm pathophysiology, multimodal prevention bundles, antimicrobial stewardship, source control, regional surveillance systems, and the disproportionate burden borne by neonatal, critical-care and technology-dependent children.
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Target exams
Red flags
- New fever, rigors or clinical deterioration in a child with a central line, urinary catheter or endotracheal tube in situ
- Line-site erythema, tenderness, pus or a tunnel/pocket infection around a vascular access device
- Bacteraemia or sepsis with coagulase-negative staphylococci, Staphylococcus aureus, enterococci, Candida or water-borne Gram-negative bacilli
- New-onset bloody or watery diarrhoea in a recently or currently antibiotic-exposed hospitalised child
- Worsening oxygenation, new infiltrates or purulent secretions after 48 hours of mechanical ventilation
- Purulent discharge, dehiscence or spreading erythema at a surgical wound within 30 (or 90) days
- A device still in place with no documented daily indication
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Current 2026 PREP curriculum — Learning Objective 2.4.4: Assess and manage infants, children and young people with infection, including healthcare-associated infection and antimicrobial resistance
- Current 2026 PREP curriculum — Learning Objective 2.4.2: Manage acute and chronic disorders in the inpatient setting, including safe use of medical devices
- Current 2026 PREP curriculum — Learning Objective 4.2: Apply quality improvement and patient-safety methods to reduce avoidable harm
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 16: Quality, safety and systems
- Clinical Applications
- Medical Sciences
- Long Cases
- Short Cases
- 7. Patient safety, including safe prescribing and infection prevention
- 9. Quality improvement: leads and participates in QI to reduce healthcare-associated harm
- General Paediatrics: Manages acutely ill and complex chronic patients in hospital, including device-related complications
- Foundation of Practice (FOP)
- Theory and Science (TAS)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- Communication
- General Pediatrics Content Outline — Domain 7: Emergency and Critical Care
- General Pediatrics Content Outline — Domain 9: Infectious Diseases
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- General Pediatrics Content Outline — Domain 11: Principles of patient safety and quality improvement
- Systems-Based Practice 1: Patient Safety
- Systems-Based Practice 2: Antimicrobial Stewardship and infection prevention
- Practice-Based Learning and Improvement 1: Quality improvement
- Patient Care 5: Patient Management
- Medical Expert
- Pediatrics: Foundations EPA #1 — Recognizing deteriorating and/or critically ill patients and initiating stabilization and management
- Collaborator and Health Advocate — preventing avoidable nosocomial harm and addressing inequity in vulnerable populations
Overview & Definition
A previously well toddler admitted for a seizure now has a central venous catheter for antibiotics, and on day five spikes a fever with a positive blood culture drawn through the line. A preterm infant in neonatal intensive care develops apnoea and a raised C-reactive protein while on parenteral nutrition through a long line. A ventilated adolescent in paediatric intensive care grows Pseudomonas from a deep respiratory specimen after a week of intubation. Each is a healthcare-associated infection, and each is bound to a device that has become its own portal of entry. [1] [12]
A healthcare-associated infection is one that was neither present nor incubating at admission, with onset conventionally more than 48 hours after admission or clearly linked to a prior healthcare exposure such as an indwelling device, a procedure, or recent hospitalisation. The device-associated subset — central-line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia or ventilator-associated event — is where prevention work yields its largest returns, because the device is a modifiable risk factor that can be inserted well, maintained well, and removed early. [1] [3] [12]
Three ideas run through this topic and bind it together. Prevent with a bundle rather than a single intervention, because device infection is multifactorial and no one action is sufficient. Survey with standard NHSN definitions so that rates are comparable across units and time, and so that outbreaks are detected. Steward devices and antimicrobials together, because every additional device-day and antibiotic-day selects for the resistant, biofilm-forming organisms that cause the hardest infections. [1] [2] [12]
From device insertion to infection prevention
- 1
Insert well
Hand hygiene, maximal sterile barriers, chlorhexidine skin preparation, optimal site selection — performed by a trained operator.
- 2
Maintain well
Aseptic access, scrub the hub, daily review of necessity, intact dressing, and removal as soon as the device is no longer essential.
- 3
Survey
Apply NHSN definitions; track CLABSI, CAUTI and ventilator-associated events as rates per 1000 device-days; feed data back to the unit.
- 4
Recognise and respond
Sample before antibiotics, remove or replace the infected device, treat with targeted antimicrobials, and review the bundle for the system failure.
References12ShowHide
- [1]Hsu HE, Mathew R, Wang R, et al. Health Care-Associated Infections Among Critically Ill Children in the US, 2013-2018. JAMA pediatrics, 2020.PMID 33017011
- [2]Weiner-Lastinger LM, Abner S, Benin AL, et al. Antimicrobial-resistant pathogens associated with pediatric healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015-2017. Infection control and hospital epidemiology, 2020.PMID 31762428
- [3]O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. American journal of infection control, 2011.PMID 21511081
- [4]Miller MR, Griswold M, Harris JM 2nd, et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts. Pediatrics, 2010.PMID 20064860
- [5]Bizzarro MJ, Sabo B, Noonan M, et al. A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit. Infection control and hospital epidemiology, 2010.PMID 20102278
- [6]Milstone AM, Elward A, Song X, et al. Daily chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicentre, cluster-randomised, crossover trial. Lancet (London, England), 2013.PMID 23363666
- [7]Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infection control and hospital epidemiology, 2014.PMID 25376073
- [8]Patel PK, Advani SD, Kofman AD, et al. Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update. Infection control and hospital epidemiology, 2023.PMID 37620117
- [9]McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2018.PMID 29562266
- [10]Schutze GE, Willoughby RE Clostridium difficile infection in infants and children. Pediatrics, 2013.PMID 23277317
- [11]Saiman L, Coffin SE, Kociolek LK, et al. Healthcare-Associated Respiratory Syncytial Virus in Children's Hospitals. Journal of the pediatric infectious diseases society, 2023.PMID 37144945
- [12]Yokoe DS, Anderson DJ, Berenholtz SM, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infection control and hospital epidemiology, 2014.PMID 25026611