scholarly journals Impact of a Central-Line Insertion Site Assessment (CLISA) score on localized insertion site infection to prevent central-line–associated bloodstream infection (CLABSI)

2019 ◽  
Vol 41 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Shruti K. Gohil ◽  
Jennifer Yim ◽  
Kathleen Quan ◽  
Maurice Espinoza ◽  
Deborah J. Thompson ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Insertion Site ◽  
Baseline Period ◽  
Central Line ◽  
Lower Percentage ◽  
Site Assessment ◽  
Central Line Insertion ◽  
Line Insertion ◽  
The Impact

AbstractObjective:To assess the impact of a newly developed Central-Line Insertion Site Assessment (CLISA) score on the incidence of local inflammation or infection for CLABSI prevention.Design:A pre- and postintervention, quasi-experimental quality improvement study.Setting and participants:Adult inpatients with central venous catheters (CVCs) hospitalized in an intensive care unit or oncology ward at a large academic medical center.Methods:We evaluated CLISA score impact on insertion site inflammation and infection (CLISA score of 2 or 3) incidence in the baseline period (June 2014–January 2015) and the intervention period (April 2015–October 2017) using interrupted times series and generalized linear mixed-effects multivariable analyses. These were run separately for days-to-line removal from identification of a CLISA score of 2 or 3. CLISA score interrater reliability and photo quiz results were evaluated.Results:Among 6,957 CVCs assessed 40,846 times, percentage of lines with CLISA score of 2 or 3 in the baseline and intervention periods decreased by 78.2% (from 22.0% to 4.7%), with a significant immediate decrease in the time-series analysis (P < .001). According to the multivariable regression, the intervention was associated with lower percentage of lines with a CLISA score of 2 or 3, after adjusting for age, gender, CVC body location, and hospital unit (odds ratio, 0.15; 95% confidence interval, 0.06–0.34; P < .001). According to the multivariate regression, days to removal of lines with CLISA score of 2 or 3 was 3.19 days faster after the intervention (P < .001). Also, line dwell time decreased 37.1% from a mean of 14 days (standard deviation [SD], 10.6) to 8.8 days (SD, 9.0) (P < .001). Device utilization ratios decreased 9% from 0.64 (SD, 0.08) to 0.58 (SD, 0.06) (P = .039).Conclusions:The CLISA score creates a common language for assessing line infection risk and successfully promotes high compliance with best practices in timely line removal.

scholarly journals Impact of a Standardized Central Line Insertion Site Assessment Score on Localized Inflammation and Infection

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Shruti K. Gohil ◽  
Jennifer Yim ◽  
Kathleen AQuan ◽  
Maurice Espinoza ◽  
Deborah Thompson ◽  
...  
Keyword(s):  
Insertion Site ◽  
Central Line ◽  
Site Assessment ◽  
Assessment Score ◽  
Central Line Insertion ◽  
Line Insertion

scholarly journals Does Nursing Shift Influence Adherence to Central-Line Maintenance Bundles?

2020 ◽  
Vol 41 (S1) ◽  
pp. s195-s195
Author(s):  
Josephine Fox ◽  
Robert Russell ◽  
Lydia Grimes ◽  
Heather Gasama ◽  
Carrie Sona ◽  
...  
Keyword(s):  
Multinomial Logistic Regression ◽  
Medical Center ◽  
Academic Medical Center ◽  
Night Shift ◽  
Insertion Site ◽  
Central Line ◽  
Central Lines ◽  
Bundle Compliance ◽  
Evening Shift ◽  
Infusion Tubing

Background: Proper care and maintenance of central lines is essential to prevent central-line–associated bloodstream infections (CLABSI). Our facility implemented a hospital-wide central-line maintenance bundle based on CLABSI prevention guidelines. The objective of this study was to determine whether maintenance bundle adherence was influenced by nursing shift or the day of week. Methods: A central-line maintenance bundle was implemented in April 2018 at a 1,266-bed academic medical center. The maintenance bundle components included alcohol-impregnated disinfection caps on all ports and infusion tubing, infusion tubing dated, dressings, not damp or soiled, no oozing at insertion site greater than the size of a quarter, dressings occlusive with all edges intact, transparent dressing change recorded within 7 days, and no gauze dressings in place for >48 hours. To monitor bundle compliance, 4 non–unit-based nurse observers were trained to audit central lines. Observations were collected between August 2018 and October 2019. Observations were performed during all shifts and 7 days per week. Just-in-time feedback was provided for noncompliant central lines. Nursing shifts were defined as day (7:00 a.m. to 3:00 p.m.), evening (3:00 p.m. to 11:00 p.m.), and night (11:00 p.m. to 7:00 a.m.). Central-line bundle compliance between shifts were compared using multinomial logistic regression. Bundle compliance between week day and weekend were compared using Mantel-Haenszel 2 analysis. Results: Of the 25,902 observations collected, 11,135 (42.9%) were day-shift observations, 11,559 (44.6%) occurred on evening shift, and 3,208 (12.4%) occurred on the night shift. Overall, 22,114 (85.9%) observations occurred on a week day versus 3,788 (14.6%) on a Saturday or Sunday (median observations per day of the week, 2,570; range, 1,680–6,800). In total, 4,599 CLs (17.8%) were noncompliant with >1 bundle component. The most common reasons for noncompliance were dressing not dated (n = 1,577; 44.0%) and dressings not occlusive with all edges intact (n = 1340; 37.4%). The noncompliant rates for central-line observations by shift were 12.8% (1,430 of 1,1,135) on day shift, 20.4% (2,361 of 11,559) on evening shift, and 25.2% (808 of 3,208) on night shift. Compared to day shift, evening shift (OR, 1.74; 95% CI, 1.62–1.87; P < .001) and night shift (OR, 2.29; 95% CI, 2.07–2.52; P < .001) were more likely to have a noncompliant central lines. Compared to a weekday, observations on weekend days were more likely to find a noncompliant central line: 914 of 3,788 (24.4%) weekend days versus 3,685 of 22,114 (16.7%) week days (P < .001). Conclusions: Noncompliance with central-line maintenance bundle was more likely on evening and night shifts and during the weekends.Funding: NoneDisclosures: None

scholarly journals The impact of central line insertion bundle on central line-associated bloodstream infection

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Hung-Jen Tang ◽  
Hsin-Lan Lin ◽  
Yu-Hsiu Lin ◽  
Pak-On Leung ◽  
Yin-Ching Chuang ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Central Line ◽  
Central Line Insertion ◽  
Line Insertion ◽  
The Impact

scholarly journals Impact of an Enhanced Prevention Bundle on Central-Line–Associated Bloodstream Infection Incidence in Adult Oncology Units

2020 ◽  
Vol 41 (S1) ◽  
pp. s256-s258
Author(s):  
Mary Kukla ◽  
Shannon Hunger ◽  
Tacia Bullard ◽  
Kristen Van Scoyoc ◽  
Mary Beth Hovda-Davis ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Medical Center ◽  
Academic Medical Center ◽  
Central Line ◽  
Team Approach ◽  
Evidence Based ◽  
Interrupted Time Series Analysis ◽  
Increased Risk ◽  
Oncology Unit ◽  
The Impact

Background: Central-line–associated bloodstream infection (CLABSI) rates have steadily decreased as evidence-based prevention bundles were implemented. Bone marrow transplant (BMT) patients are at increased risk for CLABSI due to immunosuppression, prolonged central-line utilization, and frequent central-line accesses. We assessed the impact of an enhanced prevention bundle on BMT nonmucosal barrier injury CLABSI rates. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center that houses the only BMT program in Iowa. During October 2018, we added 3 interventions to the ongoing CLABSI prevention bundle in our BMT inpatient unit: (1) a standardized 2-person dressing change team, (2) enhanced quality daily chlorhexidine treatments, and (3) staff and patient line-care stewardship. The bundle included training of nurse champions to execute a team approach to changing central-line dressings. Standard process description and supplies are contained in a cart. In addition, 2 sets of sterile hands and a second person to monitor for breaches in sterile procedure are available. Site disinfection with chlorhexidine scrub and dry time are monitored. Training on quality chlorhexidine bathing includes evaluation of preferred product, application per product instructions for use and protection of the central-line site with a waterproof shoulder length glove. In addition to routine BMT education, staff and patients are instructed on device stewardship during dressing changes. CLABSIs are monitored using NHSN definitions. We performed an interrupted time-series analysis to determine the impact of our enhanced prevention bundle on CLABSI rates in the BMT unit. We used monthly CLABSI rates since January 2017 until the intervention (October 2018) as baseline. Because the BMT changed locations in December 2018, we included both time points in our analysis. For a sensitivity analysis, we assessed the impact of the enhanced prevention bundle in a hematology-oncology unit (March 2019) that did not change locations. Results: During the period preceding bundle implementation, the CLABSI rate was 2.2 per 1,000 central-line days. After the intervention, the rate decreased to 0.6 CLABSI per 1,000 central-line days (P = .03). The move in unit location did not have a significant impact on CLABSI rates (P = .85). CLABSI rates also decreased from 1.6 per 1,000 central-line days to 0 per 1,000 central-line days (P < .01) in the hematology-oncology unit. Conclusions: An enhanced CLABSI prevention bundle was associated with significant decreases in CLABSI rates in 2 high-risk units. Novel infection prevention bundle elements should be considered for special populations when all other evidence-based recommendations have been implemented.Funding: NoneDisclosures: None

scholarly journals 1232: I’LL BE WATCHING YOU: THE IMPACT OF CENTRAL LINE INSERTION TELE-ICU OBSERVATIONS ON CLABSI RATE

2021 ◽  
Vol 50 (1) ◽  
pp. 616-616
Author(s):  
Bradley Fritz ◽  
Carrie Sona ◽  
Lisa Konzen ◽  
Jason White ◽  
Jill Bertrand ◽  
...  
Keyword(s):  
Central Line ◽  
Central Line Insertion ◽  
Line Insertion ◽  
The Impact ◽  
Clabsi Rate

The Impact of 2015 NHSN Catheter-associated Urinary Tract Infection (CAUTI) Definition Change on Central Line-associated Bloodstream Infection (CLABSI) Rates and CLABSI Prevention Efforts at an Academic Medical Center

2018 ◽  
Vol 39 (07) ◽  
pp. 878-880 ◽  
Author(s):  
Sonali D. Advani ◽  
Rachael A. Lee ◽  
Martha Long ◽  
Mariann Schmitz ◽  
Bernard C. Camins
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Bloodstream Infection ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Central Line ◽  
Academic Medical ◽  
The Impact

The 2015 changes in the catheter-associated urinary tract infection definition led to an increase in central line-associated bloodstream infections (CLABSIs) and catheter-related candidemia in some health systems due to the change in CLABSI attribution. However, our rates remained unchanged in 2015 and further declined in 2016 with the implementation of new vascular-access guidelines.Infect Control Hosp Epidemiol 2018;878–880

Insertion site inflammation was associated with central-line–associated bloodstream infections at a tertiary-care center, 2015–2018

2020 ◽  
pp. 1-3
Author(s):  
Takaaki Kobayashi ◽  
Gosia S. Clore ◽  
Mary E. Kukla ◽  
Mohammed Alzunitan ◽  
Jeffrey Kritzman ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Insertion Site ◽  
Bloodstream Infections ◽  
Central Line ◽  
Tertiary Care Center ◽  
Central Line Insertion ◽  
Line Insertion ◽  
Automated Surveillance ◽  
Site Evaluation

Abstract There are currently no guidelines for central-line insertion site evaluation. Our study revealed an association between insertion site inflammation (ISI) and the development of central-line–associated bloodstream infections (CLABSIs). Automated surveillance for ISI is feasible and could help prevent CLABSI.

Reduction of central line-associated bloodstream infections in a large acute care hospital in Midwest United States following implementation of a comprehensive central line insertion and maintenance bundle

2021 ◽  
pp. 175717742110124
Author(s):  
Abraham E Wei ◽  
Ronald J Markert ◽  
Christopher Connelly ◽  
Hari Polenakovik
Keyword(s):  
Medical Condition ◽  
Acute Care Hospital ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Annual Number ◽  
Care Hospital ◽  
Central Line Insertion ◽  
Line Insertion ◽  
The Impact

Background: Central line-associated bloodstream infection (CLABSI) is a preventable medical condition that results in increased patient morbidity and mortality. We describe the impact of various quality improvement interventions on the incidence of CLABSI in an 848-bed community teaching hospital from 1 January 2013 to 31 December 2017. Aim: To reduce CLABSI rates after implementation of a comprehensive central line insertion and maintenance bundle. Methods: A comprehensive bundle of interventions was implemented incorporating the standard US Centers for Disease Control and Prevention bundle with additional measures such as root-cause analysis of all CLABSI cases, use of passive disinfection caps on vascular access ports, standardisation of weekly central venous catheter (CVC) site dressing changes, and use of antithrombotic and antimicrobial-coated CVCs with fewer lumens. A retrospective study evaluated CLABSI rates and time of CLABSI onset after CVC placement in both intensive care unit (ICU) and non-ICU settings. Results: The annual number of CLABSI cases declined 68% (34 to 11 patients) from 2013 to 2017. There was a 30% decline in CVC days from years 2014 to 2017. Over the same period, CLABSI cases per 1000 CVC days decreased from 0.624 to 0.362: a 42% decline. Conclusion: Following the implementation of a comprehensive bundle of interventions for CVC insertion and maintenance, we found a reduction in rates of CLABSI.

scholarly journals 1174. The Impact of Multidisciplinary Central Line Stewardship Program to Decrease CLABSI Rates and Central Line Utilization Rates in an Academic Urban Medical Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S420-S421
Author(s):  
Isha Bhatt ◽  
Mohamed Nakeshbandi ◽  
Michael Augenbraun ◽  
Gwizdala Robert ◽  
Michael Lucchesi
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Blood Stream ◽  
Central Line ◽  
Mandatory Reporting ◽  
Incidence Density ◽  
Post Intervention ◽  
Improvement Project ◽  
Stewardship Program ◽  
The Impact

Abstract Background Central Line-Associated Blood Stream Infections (CLABSI) is a major healthcare dilemma, contributing to increased morbidity, mortality, and costs. We sought to reduce rates of CLABSI and device utilization by implementing a multidisciplinary Central Line Stewardship Program (CLSP). Methods In July 2017, the CLSP, multidisciplinary quality improvement project, was implemented at an academic medical center to ensure proper indication for all CVCs in the hospital and removal when no longer indicated. A CLSP team of executive leaders and infection preventionists performed daily rounds on all CVCs to review indications and maintenance. Nursing staff reported all CVCs daily. Information Technology modified the electronic health record to require daily physician documentation of CVC placement and indications, and to suggest alternatives to CVC when possible. In the event of a CLABSI, a root cause analysis was conducted within 72 hours, and feedback was shared with the clinical staff. A retrospective review was conducted 18 months before and after CLSP implementation. As a facility in a state with mandatory reporting of hospital-acquired infections, institutional data were readily available through the National Healthcare Safety Network (NHSN). To compare rates of CLABSI and device utilization pre- and post-CLSP, we reviewed the Incidence Density Rate (IDR), the standardized infection ratio (SIR), and standardized utilization ratio (SUR). Data from the NHSN website were analyzed using statistical tools provided by the NHSN analysis module. Two-tailed significance tests were conducted with α set at 0.05. Results Post-CLSP, there was a statistically significant decrease in SIR from 1.99 to 0.885, with risk reduction by 44.3% (P = 0.013, 95% CI 0.226 -0.831). CLABSI IDR per 1000 CVC days declined from 1.84 to 0.886 (P = 0.0213). CVC utilization per 1000 patient-days reduced from 155.08 to 142.35 (P < 0.001). There was also a trend toward fewer PICC line infections post-intervention (17 to 5). Conclusion With this novel CLSP, we achieved a significant reduction in rates of CLABSI and device utilization, suggesting that a multidisciplinary approach can promote sustainable prevention of line-associated infections through dedicated surveillance of CVC indications and maintenance. Disclosures All authors: No reported disclosures.

Which Central Line Insertion Site Is the Least Prone to Infection?

2013 ◽  
Vol 61 (3) ◽  
pp. 362-363
Author(s):  
Murtaza Akhter ◽  
Dan Runde ◽  
Jarone Lee
Keyword(s):  
Insertion Site ◽  
Central Line ◽  
Central Line Insertion ◽  
Line Insertion
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