The Effect of Electronic Health Record-Based Central Line Maintenance Documentation on CLABSI Rates across Intensive Care Units at a Pediatric Hospital

Abstract

Background

Central line-associated bloodstream infections (CLABSIs) are a significant concern in pediatric intensive care units (PICUs), leading to increased morbidity and limited treatment options. Electronic health record (EHR)-based documentation for monitoring CLABSIs may enhance bundle compliance and reduce infection rates. However, data in pediatric settings are limited.

Objective

This study evaluated the impact of transitioning from paper-based to EHR-based documentation for central line maintenance on CLABSI rates in intensive care units (ICUs).

Methods

A retrospective cohort study was conducted between the paper-based period and EHR-based period in the neonatal (NICU), pediatric surgery (PSICU), and pediatric (PICU) ICUs. CLABSI prevention bundle compliance was assessed using manual checklists in the paper-based period and EHR-based documentation in the EHR-based period. CLABSI rates were calculated per 1,000 catheter-days, and bundle adherence was tracked using manual checklists or EHR-based documentation.

Results

Among 3,278 patients, overall CLABSI rates decreased from 5.32 to 2.46 per 1,000 catheter-days (p = 0.008). In the NICU, rates dropped from 6.20 to 2.13 (p = 0.028); in the PSICU, from 1.45 to 0; and in the PICU, from 5.38 to 3.24 per 1,000 catheter-days (p > 0.05).

Conclusion

Transitioning to EHR-based documentation for central line maintenance significantly reduced CLABSI rates across PICUs, particularly in the NICU. EHR systems improve compliance monitoring, promote standardization, and represent an effective tool for strengthening infection prevention in pediatric critical care.

Keywords

Central Line-Associated Bloodstream Infection (CLABSI) - electronic health records (EHR) - infection prevention bundle - pediatric intensive care units - bundle compliance/adherence

Protection of Human and Animal Subjects

This study involving human subjects was reviewed and approved by the Institutional Review Board (IRB). All procedures were conducted in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki Declaration and its later amendments. Informed consent was obtained from all participants prior to inclusion in the study.

Contributors' Statement

I.D.: conceptualization, formal analysis, methodology, writing–original draft, writing–review and editing. H.O.: data curation, methodology. Y.O.: investigation, resources. C.D.: investigation, resources. O.Y.: investigation. M.C.: investigation. T.O.: investigation, resources. N.T.: investigation. T.B.: investigation, resources. G.O.P.: investigation, methodology. U.K.: investigation, methodology. A.S.: supervision, writing–original draft, writing–review and editing. H.A.: supervision, writing–review and editing.

Publication History

Received: 07 November 2025

Accepted after revision: 19 March 2026

Article published online:
31 March 2026

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