Central Line Associated Bloodstream Infection Prevention

Health care-associated infections (HAIs) are infections patients acquire during the course of receiving treatment for other conditions. HAIs account for an estimated 2 million infections, 90,000 deaths, and $4.5 billion in excess health care costs annually . The Healthcare-Associated Infection Work Group (HAIWG) was established to provide recommendations for the surveillance and prevention of selected HAIs in Utah Hospitals, and has representation from the Utah Department of Health (UDOH), the Utah Hospitals and Health Systems Association (UHA), Health Insight, Infection Control Professionals (ICPs) and Infectious Disease Physicians from all major healthcare corporations in Utah.

Selection of an HAI to measure was based on the frequency, severity, preventability of the outcome and the likelihood that the selected HAI could be detected and reported accurately. Although central line-associated bloodstream infections (CLA-BSI) occur at relatively low rates, they are the most easily identified HAI and are associated with substantial morbidity and mortality and excess health care costs. In addition , there are well-established prevention strategies for CLA-BSIs.

In order to standardize the outcome measurement, ICPs from across Utah adopted an objective CLA-BSI case definition that operationalizes the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) criteria. In addition, rather than dictate state-wide implementation of selected prevention processes, the UDOH expects Utah Hospitals to conduct their own local risk assessment with improvement efforts to target the highest risk failure modes.

Administrative Rule R386-705

This administrative rule from the UDOH establishes the mandatory reporting requirements for CLA-BSI acquired in Utah Hospital intensive care units. Read more about Rule R386-705.

Failure Modes Effect Analysis (FMEA) for CLA-BSI

FMEA is widely used in the manufacturing industries and is now being used in health care to assess the risk of failure and harm in processes in order to identify the most important areas for process improvements. The UDOH expects hospitals to use this tool to conduct their own assessments to identify the highest risk failures leading to CLA-BSI. Please see the FMEA materials below to determine how to best utilize this effective analytical approach to improve the care processes given to your patients.

Web Resources For the Prevention of CLA-BSI

There are multiple web sites that provide resources and tools to help facilities lower the occurrence of CLA-BSIs.

  • The Department of Hospital Epidemiology and Infection Control at the Johns Hopkins Health System website has extensive resources related to prevention of central line associated bloodstream infection (educationalpowerpoint slides and post test questions, nursing checklist, central line policy.)
  • The New England Journal of Medicine website has 2 clinical videos that demonstrate physician insertion of central venous catheters (internal jugular andsubclavian.) To access the videos, one must have a subscription to the journal.
    Search for: videos in clinical medicine AND central venous catheter
    Click on the Full Text link to the following and can access video clips:
    Central Venous Catheterization (N Engl J Med 356:e21, May 24,2007)
    Central Venous Catherization - Subclavian Vein (N Engl J Med 357:e26, Dec 13, 2007.)
  • The Institute for Healthcare Improvement (IHI) is an independent not-for-profit organization helping to lead the improvement of health care throughout the world. IHI has promoted the use of bundling. Care bundles, in general, are groupings of best practices with respect to a disease process that individually improve care, but when applied together result in substantially greater improvement. The Central Line Bundle is a group of evidence-based interventions for patients with intravascular central catheters that, when implemented together, result in better outcomes than when implemented individually. The central line bundle consists of 5 key components which include:Hand hygieneMaximal barrier precautions upon insertionChlorhexidine skin antisepsisOptimal catheter site selectionDaily review of line necessity
  • A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals by SHEA.
  • Infection Control and Hospital Epidemiology published by The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America.

Resources/Tools developed at Utah Hospitals to lower CLA-BSI

Resources and tools that were developed and in use for quality improvement at local Utah hospitals to provide education, observe, monitor, and facilitate best practices for central line insertion and care are shared below for other facilities to use and adapt as they choose. Note that policies for central line care may differ by facility or even within a facility based on work flow processes. These tools and resources are to be used as a guide.

  • Resource: "Be a life SAVER" Online Educational Module: An Intermountain Healthcare produced online educational tool that effectively instructs healthcare workers on the proper care and maintenance of central venous catheters (CVC). Proper line care reduces the possible risk of blood stream infections occurring in patients with central lines. This web tool provides interactive vignettes and test materials for use a stand alone educational module. Note that policies for central line care may differ by facility, and practices continually change based on new research. For example, future INS guidelines are expected to recommend sutureless securement devices.
  • xlsTool: Central Line Care and Hub Access Observation Checklist: For nursing staff to audit catheter/tubing maintenance and central line access.
  • xlsTool: ICU Daily Goals Sheet: This is a form that physicians, nurses, respiratory therapy, and pharmacists use to communicate goals of care for individual patients, and includes a section relating to device use.