Jun, 02nd 2011

Setting Goals: Preventing Central Line Infections

Central line-associated bloodstream infections have been linked to negative outcomes, such as increased lengths of hospital stays and increased healthcare costs. Based on research, each episode of the infection can increase healthcare costs anywhere from $3,700 to $29,000. The Joint Commission’s National Patient Safety Goal 07.04.01 requires hospitals to implement strategies to prevent central line-associated bloodstream infections.

The goal covers short-term and long-term central venous catheters and peripherally inserted central catheter (PICC) lines. Hospitals that are accredited by The Joint Commission must implement practices and policies that align with regulatory requirements and evidence-based standards.

Additional Joint Commission requirements for preventing central line infections include the following:

  • Perform hand hygiene before inserting or manipulating a catheter.
  • Avoid inserting catheters into femoral veins in adults unless other sites are unavailable.
  • Use a standardized, all-inclusive supply cart or kit for central venous catheter insertion.
  • Implement standardized protocol for maximum sterile barrier precautions during catheter insertion and for disinfecting catheter hubs and injection ports before accessing them.
  • Use a chlorhexidine-based antiseptic product to prepare the skin of patients older than age 2 months, unless contraindicated. (Povidine-iodine can be used for patients under age 2 months.) 
  • Assess all central venous catheters routinely and remove nonessential catheters.

Hospitals should consider focusing their strategy on the implementation of evidence-based practices, such as those listed in the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals. The Compendium lists best practices that should be implemented before, during, and after insertion of a central line catheter as well as recommendations for performance measures.

For example, the Compendium recommends the use of a catheter-insertion checklist. Likewise, The Joint Commission’s element of performance requires hospitals to use a catheter-insertion checklist and to establish a standardized protocol to prevent infections. Although this element of performance has a documentation requirement, The Joint Commission does not require that the checklist be a part of the medical record. Instead, surveyors will look for evidence that the checklist or protocol was completed. So the use of a checkbox or a brief note stating that the checklist or protocol was completed can meet this requirement.

Sample Checklist
The central line insertion checklist may include the insertion date and time, a description of the insertion site, and the line removal date. Staff should also indicate whether or not a known infection is present at the time of removal. The checklist should also verify that these actions are taken before or during the insertion of the central line:

  • Wash and disinfect hands.
  • Wear a head cover and mask.
  • Use a chlorhexidine-based antiseptic for skin preparation.
  • Wear a sterile surgical gown and gloves.
  • Use a full body drape to cover the patient.

Strategies for preventing central line-associated infections should also include education of physicians, nurses, and other healthcare personnel to explain information about the hospital’s guidelines, use of the catheter insertion checklist, and catheter maintenance. A review of the hospital’s infection rates and evaluation of the effectiveness of prevention efforts should also take place.

For more information, visit the Joint Commission’s website or call their Standards Interpretation Group at (630) 792-5900.

References: 

Render ML, et al. Codman Awards: Evidence-based practice to reduce central line infections. Joint Commission Journal of Quality and Patient Safety. 2006. 32(5): 253–260.

Society for Healthcare Epidemiology of America (SHEA). Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals. SHEA Web site. http://www.shea-online.org/about/compendium.cfm Accessed July 16, 2009.
The Joint Commission. Central line-associated bloodsteam infection (CLABSI). The Joint Commission Web site. http://www.jointcommission.org/AccreditationPrograms/Hospitals/Standards/09_FAQs/NPSG/Healthcare_associated_infections/NPSG.07.04.01/central_line_associated_bloodstream_infection.htm. Accessed July 16, 2009.


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