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) may 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;
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
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

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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 unless there is a
documented contraindication to CHG
o Povidone iodine, alcohol, CHG, or other specified for children <60 days old
 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.

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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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