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Licensing and Certification Program

​​NHSN Instructions for Use of CLIP Module

Central Line Insertion Practices Adherence Monitoring

Introduction: Central line-associated bloodstream infections (CLABSIs) can be prevented through proper management of the central line. The CDC’s Healthcare Infection Control Practices Advisory Committee (CDC/HICPAC) Guidelines for the Prevention of Intravascular Catheter-Related Infections recommend evidence-based central line insertion practices known to reduce the risk of subsequent central line-associated bloodstream infection. These include use of maximal sterile barriers during insertion, proper use of a skin antiseptic prior to insertion, avoiding the femoral insertion site whenever possible, and avoiding guidewire exchange when a central line-associated infection is suspected. Despite the scientific evidence supporting these measures, several reports suggest that adherence to these practices remains low in US hospitals.

Several centers have found it useful to monitor adherence to evidence-based central line insertion practices as a method for identifying quality improvement opportunities and strategically targeting interventions. Feedback of adherence data has been a component of multifaceted interventions that have successfully reduced CLABSI rates. There is currently no systematic method to collect information on central line insertion practices.

The proposed additional collections in NHSN would enable participating facilities and CDC to: 

  1. Monitor central line insertion practices in individual patient care units and facilities and to provide aggregate adherence data for all participating facilities. Facilities have the option of recording inserter-specific adherence data. 
  2. Link gaps in recommended practice with the clinical outcome (i.e., CLABSI) both in individual facilities and for all participating facilities. 
  3. Facilitate quality improvement by identifying specific gaps in adherence to recommended prevention practices, thereby helping to target intervention strategies for reducing central line-associated bloodstream infection rates.

Settings: Surveillance will occur in any of four locations: (1) intensive care units (ICU), (2) specialty care areas (includes hematology/oncology wards, bone marrow transplant units, inpatient dialysis units, long term acute care units), (3) neonatal intensive care units (NICU), and (4) any other patient care location in the institution (e.g., surgical wards).

Requirements: Surveillance for central line insertion practices in at least one location in the healthcare institution for at least one calendar month as indicated in the Patient Safety Monthly Reporting Plan (CDC 57.75A). Participating facilities may perform surveillance for insertion practices during a month when concomitant CLABSI surveillance is being conducted, or may collect insertion practice data during a month
when no CLABSI surveillance is being conducted. If participating facilities wish to produce reports that link insertion practices to outcome (i.e., CLABSI), surveillance for insertion practices and CLABSI must be done concomitantly.

Methods: The Central Line Insertion Practices Adherence Monitoring Form (CDC 57.75JJ) is used to collect and report central line insertion practices for each central line insertion occurring during the month selected for surveillance. The Instructions for Completion of the Central Line Insertion Practices Adherence Monitoring Form (Table 20) contains brief instructions for collection and entry of each data element on the form. The form can be completed at or near the time of insertion either by the inserter or an observer present at the insertion (e.g., nurse assisting with the catheter insertion), or the form can be completed from documentation in the patient chart (e.g., if the elements of the monitoring form have been incorporated into standard central-line insertion procedure notes). The Central Line Insertion Practices Adherence Monitoring form should be completed for every central line insertion that occurs during the month chosen for surveillance. The form includes information pertaining to demographics of the patient (shown also as CDC 57.75C), information pertaining to the inserter and the person completing the form, information on maximal sterile barriers used, the reasons for central line insertion, skin antisepsis, hand hygiene practice before insertion, type of central line and insertion site, and use of a guidewire. These data will be used to calculate adherence to recommended catheter insertion practices.   

Data Analyses: Adherence rates for specific insertion practices will be calculated by dividing the number central line insertions during which recommended practice was followed by the total number of central line insertions and multiplying the result by 100. This calculation will be performed separately for different types of ICU, specialty care areas, NICUs, and other locations in the institution. Participants have the option of calculating inserter-specific adherence rates. An additional option for analysis is to generate a line list of patients in whom a central line was inserted, the insertion practices followed during the insertion, and information on any subsequent CLABSI associated with that central line.


Table. Instructions for Completion of the Central Line Insertion Practices Adherence Monitoring Form (CDC 57.75JJ)

Data Field Instructions for Form Completion
​Facility ID ​Required. Facility identification number will be autoentered by the computer
​Event # ​Required. Event number will be autogenerated by the computer
​Patient ID ​Required. Enter the patient ID. This is the patient identifier assigned by the facility and may consist of any combination of numbers and/or letters

​Social Security #
Secondary ID
Patient name: Last, first, middle
Gender

​Optional. Enter patient’s Social Security Number

Optional. Enter any other patient identifier assigned by the facility.

Optional. Enter patient’s last name, first name and middle name

Required. This is the gender of the patient. Check male or female.

​Date of Birth ​Required. Enter the patient’s date of birth (MM/DD/YYYY).
​Ethnicity (specify) ​Optional. Enter the patient’s ethnicity:
Hispanic or Latino
Not Hispanic or Not Latino
​Race (specify) ​Optional. Enter the patient’s race: (select all that apply)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

​Event Type

Location

​Required. Event Type “CLIP” will be autoentered.

Required. Enter the location of the patient at the time of the central line insertion

​Insertion date

Person recording insertion practice data

​Required. Enter the date of central line insertion (MM/DD/YYYY).

Required. Select inserter or observer.

​Central line inserter ID

Name, Last, First

​Optional. Enter the HCW ID# of the person inserting the central line.

Optional. Enter last name and first name of person inserting the central line.

​Occupation of inserter

 

​Required. Check the occupational category of the person inserting the central line Attending physician; Intern/Resident; Physician assistant; IV team; Fellow; Other medical staff; Medical student; Other student. If Other than these, please specify:
​Reason for insertion ​Required. Check the primary reason for inserting the central line: New indication; Replace malfunctioning central line; Suspected central line-associated infection. If Other, please specify.
​Inserter performed hand hygiene prior to central line insertion ​Required. Check Y (Yes) if the inserter appropriately performed hand hygiene prior to inserting central line; otherwise check N (No). Appropriate hand hygiene includes the use of alcohol-based hand rub or soap and water hand wash.
​Maximal sterile barrier precautions used ​Required. Check each sterile barrier used during insertion:
Mask/Eye shield; Sterile gown; Large sterile (full body) drape; Sterile gloves; Cap
​Skin preparation ​Required. Check all that apply: Chlorhexidine gluconate; Povidone iodine; Alcohol
​Was skin preparation agent completely dry at time of first skin puncture? ​Required. Check Y (Yes) if the skin prep agent was allowed to dry completely at the time of first skin puncture; otherwise select N (No).
​Insertion site ​Required. Check the site of insertion of the central line: Jugular; Subclavian; Umbilical; Femoral; Upper extremity (PICC).
​Antimicrobial coated catheter used ​Optional. Check Y (Yes) if antimicrobial coated catheter was used; otherwise check N (No).
​Central line catheter type ​Required. Check the type of central line inserted:
Non-tunneled catheter (other than dialysis); Tunneled catheter (other than dialysis); Dialysis catheter non-tunneled; Dialysis catheter tunneled; Umbilical; PICC. If other, please specify.
​Number of lumens ​Required. Circle the number of lumens in the device: 1, 2, 3 or > 4.
​Central line exchanged over a guidewire ​Required. Check Y (Yes) if the central line was exchanged over a guidewire; otherwise Check N (No).

​Antiseptic ointment applied to site

 

Custom Fields and Labels

​Required. Check Y (Yes) if antiseptic was applied to the insertion site following insertion but prior to application of the dressing; otherwise check N (No).

Optional. Up to two date fields and 10 alphanumeric fields that may be customized for local use. NOTE: Each custom field must be set up in the Facility/Custom Options section of the application before the field can be selected for use.

​Comments ​Optional. Enter any additional information on the central line insertion

 

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