More than 100,000 patients in California hospitals have a central line inserted each year. Contamination of the line during insertion can cause infection, often resulting in serious illness and substantial increased healthcare costs. It is estimated that more than half of CLABSIs may be preventable if hospitals adhere to all of the recommended central line insertion practices (CLIP), which together are called a bundle, for each central line insertion. The CLIP bundle includes eight components: hand hygiene, recommended skin preparation agent, allowing the skin preparation agent to dry, and five maximal sterile barriers (cap, mask, gown, gloves, and drape). Hospitals can monitor and enforce adherence to the CLIP bundle by using a checklist.
This is the third California Department of Public Health (CDPH) report on central line insertion practices (CLIP) in intensive care units, including neonatal intensive care units. This report summarizes data reported to the California Department of Public Health (CDPH) through the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) from January 1, 2011 through December 31, 2011. Complete adherence to all of the recommended practices increased to 95.7% of insertions for January 1, 2011 through December 31, 2011 compared to 94.9% for April 1, 2010 through March 31, 2011. For the 2011 reporting period, the CDPH Healthcare-Associated Infections (HAI) Program contacted all hospitals to ensure that complete CLIP observation data were submitted to NHSN, resulting in reporting compliance of 98.7% of hospitals. California is the first state to issue a public report on CLIP adherence.
Adherence to the CLIP bundle is defined as the following eight individual components during each central line insertion:
Maximal sterile barriers
- Hand hygiene
- Appropriate skin preparation agent
- Allowing the skin preparation agent to dry
This report provides information to help hospitals begin or continue to use CLIP data as a quality improvement tool. Hospitals may also link CLIP data with central-line associated bloodstream infection (CLABSI) data to connect prevention practices with infection outcomes.
The public and consumers can use information in this report to ask their healthcare providers about strategies their hospital uses to prevent CLABSIs, including monitoring CLIP adherence, and ask about CLIP adherence results. Consumers can also ask their healthcare providers about actions they can take to ensure their safety in the hospital, including protecting against CLABSIs.