This is the first 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, 2009 through March 31, 2010. California is the first state to issue a public report on CLIP adherence.
Adherence to the CLIP bundle is defined as following eight individual components during each central line insertion:
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Maximal sterile barriers
- Cap
- Mask
- Gown
- Gloves
- Drape
- Hand hygiene
- Appropriate skin preparation agent
- Allowing the skin preparation agent to dry
For this reporting period, hospitals were able to report CLIP data using the following two methods
- Report the complete CLIP dataset “in-plan,” including the eight components of the CLIP bundle. “In-plan” reporting meant that forms could only be saved in NHSN if all required data fields were complete.
- Report a subset of the CLIP dataset “out-of-plan,” in which some data fields, including one bundle component (whether the skin preparation agent was dry before skin puncture), were not required. “Out-of-plan” reporting meant that forms could be saved in NHSN even if some data fields were incomplete.
Adherence was defined in two ways based on the reporting methods described above:
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“In-plan” adherence: Any CLIP observation in which all eight bundle components were followed, i.e., all components were “yes.”
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“Out-of-plan” adherence: Any CLIP observation where all seven bundle components were followed, i.e., all seven components were “yes.”
This report provides CLIP adherence for both “in-plan” and “out-of-plan” reporting methods. Some hospitals reported CLIP observations under both methods and therefore have adherence presented for both types of reporting.
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.