Quality Process Measures/Metrics
- Complete documentation elements
- Number of operator attempts per line placement
- % of patients with site disinfection per protocol
- % insertion with completed checklist
- Bundle compliance – insertion and maintenance to be measured separately
- % of line insertions following all bundle components
- Hospitals can choose to include additional bundle components. Including more than 5 may confuse and overwhelm providers.
- % of patients/families educated about infection prevention
- Repetitive patterns, trends, or variables
- Complication rate
- PICC v. Central Lines
- Insertion site choice
- Perform a minimum of 20 audits per month. If procedures are fewer than 20, then include all procedures.
Technology Plan
The recommendations of specific technologies or products herein are those of the Patient Safety Movement Foundation and do not necessarily represent the opinions of the Joint Commission Center for Transforming Healthcare or its affiliates. The Joint Commission Center for Transforming Healthcare was not consulted on, nor did it participate in the decision or choice of any specific product or technology, and as a matter of policy the JointCommission Center for Transforming Healthcare does not endorse any specific technologies, equipment, or other products.
Implement a central venous catheterization (CVC) kit to prepare, insert and maintain a safe central line. Kits can be custom designed to fit the needs of one hospital or hospital system. Two such kits are used at the University of Vermont Medical Center and have been included below:
- Arrow International® PSI Kit with Integral Hemostasis Valve/Side Port.
- Arrow International® Pressure Injectable Quad-Lumen Central Venous Catheterization Kit with Blue FlexTip®, ARROWg+ard Blue PLUS® Catheter and Sharps Safety Features.
Consider implementing Electronic Hand Hygiene Compliance technology to ensure accurate and reliable measurement, feedback and improvement of this essential performance indicator.
- See APSS 2A for detailed information on the evidence in support of electronic solutions to measure hand hygiene behavior and a list of technology suppliers.
Metrics
Topic:
Central line-associated bloodstream infections (CLABSI)
Rate of CLABSI (healthcare-associated primary bloodstream infection (BSI)) in an ICU patient that had a central line within the 48-hour period before the development of the BSI and that is not related to an infection at another site.
Outcome Measure Formula:
Numerator: A laboratory-confirmed bloodstream infection based on CDC NHSN definitions \cite{0031}
Denominator: Device days or patient days
*Rate is typically displayed as CLABSI/1000 Line days
Metric Recommendations:
Indirect Impact:
Any patient with a peripheral or central line will benefit from several of the interventions being instituted
Direct Impact:
All patients that require a central line
Lives Spared Harm: