Att G6_Central Line Insertion Practices Adherence

Device-associated Module
CLIP

Central Line Insertion Practices (CLIP) Adherence Monitoring
Introduction: Central line-associated bloodstream infections (CLABSIs) can be prevented
through proper placement and 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, 20111 recommend evidence-based
central line insertion practices known to reduce the risk of subsequent central line-associated
bloodstream infection. These include hand hygiene by inserters, use of maximal sterile
barriers during insertion, proper use of a skin antiseptic prior to insertion, and time to allow
the skin antiseptic to dry before catheter insertion.
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.
Participation in NHSN CLIP surveillance enables participating facilities and CDC to:



Monitor central line insertion practices in individual patient care units and facilities and
provide aggregate adherence data for all participating facilities. Facilities have the option
of recording inserter-specific adherence data.
Facilitate quality improvement by identifying specific gaps in adherence to recommended
prevention practices, thereby helping to target intervention strategies for reducing
CLABSI rates.

Participating facilities may perform surveillance for insertion practices during the following:
 a month when concurrent CLABSI surveillance is being conducted;
 a month when no CLABSI surveillance is being conducted; and
 in locations where CLABSI are not monitored (e.g., emergency department, operating
room, etc.).
If participating facilities wish to identify associations between insertion practices and
outcomes (i.e., CLABSI), surveillance for insertion practices and CLABSI must be done
concurrently.
Settings: Surveillance may occur in any type of patient care location where central lines are
inserted.
Numerator and Denominator Data: The Central Line Insertion Practices Adherence
Monitoring Form (CDC 57.125) is used to collect and report central line insertion practices
for every central line insertion attempt, including unsuccessful attempts, occurring during the
month in the unit(s) selected for surveillance. The Table of Instructions for Completion of the
Central Line Insertion Practices Adherence Monitoring Form contains directions for
collection and entry of each data element on the form. The form can be completed at or near
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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 (only if all elements of the monitoring form have been incorporated into
standard central-line insertion procedure notes). The form includes information pertaining to
demographics of the patient, information pertaining to the inserter, information on maximal
sterile barriers used, the reason for central line insertion, whether the insertion was
successful, skin antisepsis, hand hygiene practice before insertion, type of central line
including whether it was antimicrobial coated, insertion site and, if placed because of
suspected existing central line infection, the use of a guide wire. Elements of these data will
be used to calculate adherence to recommended insertion practices.
Data Analyses: Adherence rates for specific insertion practices will be calculated by
dividing the number of central line insertions during which the recommended practice was
followed by the total number of central line insertions and multiplying the result by 100.
Such calculations can also be done for a bundle of practices that have been shown to reduce
the incidence of CLABSI (i.e. NHSN CLIP Bundle). In NHSN for CLIP insertions dated
January 1, 2014 and forward, adherence to the bundle requires a “Yes” to all of the
following:
 Hand hygiene performed
 Appropriate skin prep*
o Chlorhexidine gluconate (CHG) for patients ≥60 days old
o CHG for patients < 60 days old when either there is no contraindication to
CHG or contraindication is unknown
o Povidone iodine, alcohol, CHG, or other specified for children <60 days old
when there is a contraindication to CHG
 Skin prep agent has completely dried before insertion
 All 5 maximal sterile barriers used
o Sterile gloves
o Sterile gown
o Cap
o Mask worn
o Large sterile drape (a large sterile drape covers the patient’s entire body)
Note: These calculations are performed separately for different types of locations in the
institution. Participants have the option of calculating inserter-specific adherence rates.
*The Food and Drug Administration (FDA) has labeled CHG to be used with care in
premature infants and infants < 2 months of age. Therefore, for patients < 60 days NHSN
will accept documented use of any of the listed skin prep agents as an acceptable portion of
the NHSN CLIP Bundle adherence when there is a contraindication to CHG. Acceptance of
CHG use for adherence to the CLIP bundle in this patient population does not reflect a
recommendation of its use by the NHSN.

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REFERENCES
O’Grady, NP., Alexander, M., Burns, LA., Dellinger, EP., Garland, J., Heard, SO.,
Maki, DG., et al. “Guidelines for the Prevention of Intravascular Catheter-related Infections”.
Clinical Infectious Diseases 52 (a): (2011): 1087-99.

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1 Instructions for Completion of the Central Line Insertion
Practices Adherence Monitoring Form (CDC 57.125)
Data Field
Facility ID

Instructions for Form Completion
The NHSN-assigned facility ID will be auto-entered by the computer.

Event #

Event ID number will be auto-entered by the computer.

Patient ID

Required. Enter the alphanumeric patient ID number. This is the
patient identifier assigned by the hospital and may consist of any
combination of numbers and/or letters.
Optional. Enter the 9-digit numeric patient Social Security Number.
Optional. Enter the alphanumeric ID number assigned by the facility.
Conditionally required. Enter the patient’s Medicare number for all
events reported as part of a CMS Quality Reporting Program.
Optional. Enter the last, first, and middle name of the patient.

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

Required. Check Female, Male or Other to indicate the gender of the
patient.
Date of Birth
Required. Record the date of the patient birth using this format:
MM/DD/YYYY.
Ethnicity
Optional. Specify if the patient is either Hispanic or Latino, or Not
Hispanic or Not Latino.
Race (specify)
Optional. Check all the boxes that apply to identify the patient’s race.
Event Type
Required. CLIP.
Location
Required. Enter the location of the patient at the time of the central
line insertion.
Date of insertion
Required. Enter the date of central line insertion (MM/DD/YYYY).
Person recording insertion Required. Select inserter or observer.
practice data
Central line inserter ID
Optional. Enter the HCW ID# of the person inserting the central line.
Name, Last, First
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: Fellow; Medical student; Other student; Other medical
staff; Physician assistant; Attending physician; Intern/resident;
Registered Nurse, Advanced Practice Nurse; Other. If Other, please
specify.
Was inserter a member of Required. Select Y if the inserted was a member of PICC/IV team;
PICC and/or IV Team?
otherwise select N.
Reason for insertion
Required. Check the primary reason for inserting the central line: New
indication (e.g., hemodynamic monitoring, fluid/medication administration,
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etc.); Replace malfunctioning central line; Suspected central line-

associated infection. If Other, please specify.
If Suspected central line- Conditionally required. Answer this only if reason for insertion is
associated infection, was suspected central line-associated infection. Check Y if the central line
the central line exchanged was exchanged over a guidewire; otherwise Check N.
over a guidewire?
Inserter performed hand
Required. Check Y if the inserter appropriately performed hand
hygiene prior to central line hygiene prior to inserting central line; otherwise check N. Appropriate
insertion
hand hygiene includes the use of alcohol-based hand rub or soap and
water hand wash. If not observed directly, ask inserter.
Maximal sterile barriers
Required. Indicate whether each of the 5 barriers was used
used
appropriately, by checking Y or N.
NOTE: If inserter wore either a mask or a mask with eye shield, the Y
box for Mask should be checked.
Skin preparation
Required. Check all that apply: Chlorhexidine gluconate; Povidone
iodine; Alcohol; Other. If Other is chosen, specify prep used.
If skin prep choice was not Conditionally required. Answer this only if chlorhexidine gluconate
chlorhexidine gluconate, (CHG) was not used as the skin prep. Check Y if the patient did have
was there a
a contraindication to CHG; Check N if the patient did not have a
contraindication to
contraindication to CHG; Check U if CHG contraindication was
chlorhexidine gluconate? unknown.
If contraindication to chlorhexidine, choose at least one of the following:

For patients < 60 days old on the date of event any skin prep
documented will fulfill the skin prep portion of the CLIP bundle.
For patients ≥ 60 days old on the date of event, CHG must be one of
the preps used UNLESS one of the following is a documented
contraindication:
1)Patient has a documented/known allergy/reaction to CHG based
products that would preclude its use, or
2) Facility restrictions or safety concerns for CHG use in premature
infants precludes its use.
Was skin preparation agent
completely dry at time of
first skin puncture?
Insertion site

Antimicrobial coated
catheter used
Central line catheter type
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Required. Check Y if the skin prep agent was allowed to dry
completely at the time of first skin puncture; otherwise select N. If not
observed directly, ask inserter.
Required. Check the site of insertion of the central line: Femoral;
Jugular; Lower extremity; Scalp; Subclavian; Umbilical; Upper
extremity.
Optional. Check Y if antimicrobial coated catheter was used;
otherwise check N.
Required. Check the type of central line inserted:
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Did this insertion attempt
result in a successful
central line placement?
Custom Fields

Comments

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Non-tunneled (other than dialysis); Tunneled (other than dialysis);
Dialysis non-tunneled; Dialysis tunneled; PICC; Umbilical. If other,
please specify. ‘Other’ should only be marked when none of the other
options apply and should not be used to specify brand names or
number of lumens. Most lines can be categorized accurately by
selecting from the options provided.
Required. Check Y if attempt was successful; otherwise check N.

Optional. Up to 50 fields may be customized for local or group use in
any combination of the following formats: date (MMDDYYYY),
numeric, or alphanumeric.
NOTE: Each Custom Field must be set up in the Facility/Custom
Options section of NHSN before the field can be selected for use. Data
in these fields may be analyzed.
Optional. Enter any additional information on the central line
insertion.

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