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

Published online by Cambridge University Press:  08 November 2019

Shruti K. Gohil
Affiliation:
Epidemiology & Infection Prevention Program, University of California, Irvine Health, Orange, California Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
Jennifer Yim
Affiliation:
Epidemiology & Infection Prevention Program, University of California, Irvine Health, Orange, California
Kathleen Quan
Affiliation:
Epidemiology & Infection Prevention Program, University of California, Irvine Health, Orange, California
Maurice Espinoza
Affiliation:
University of California, Irvine Health, Orange, California
Deborah J. Thompson
Affiliation:
Epidemiology & Infection Prevention Program, University of California, Irvine Health, Orange, California
Allen P. Kong
Affiliation:
Department of Surgery, University of California, Irvine School of Medicine, Irvine, California
Bardia Bahadori
Affiliation:
Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
Tom Tjoa
Affiliation:
Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
Chris Paiji
Affiliation:
Department of Medicine, University of California, Irvine School of Medicine, Irvine, California
Scott Rudkin
Affiliation:
Department of Emergency Medicine, University of California, Irvine School of Medicine, Irvine, California
Syma Rashid
Affiliation:
Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
Suzie S. Hong
Affiliation:
Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
Linda Dickey
Affiliation:
Epidemiology & Infection Prevention Program, University of California, Irvine Health, Orange, California
Mohamad N. Alsharif
Affiliation:
Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
William C. Wilson
Affiliation:
Department of Anesthesia, University of California, Irvine School of Medicine, Irvine, California University of California, Irvine Health, Orange, California
Alpesh N. Amin
Affiliation:
Department of Medicine, University of California, Irvine School of Medicine, Irvine, California University of California, Irvine Health, Orange, California
Justin Chang
Affiliation:
Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
Usme Khusbu
Affiliation:
Epidemiology & Infection Prevention Program, University of California, Irvine Health, Orange, California
Susan S. Huang
Affiliation:
Epidemiology & Infection Prevention Program, University of California, Irvine Health, Orange, California Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
Corresponding
E-mail address:

Abstract

Objective:

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.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: These data were presented in part at the Infectious Disease Society of America (IDSA) Annual Meeting on October 27, 2016, in San Diego, California.

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