The implementation of a novel central-line insertion site assessment score reduced the prevalence of lines with local inflammation or infections, ensured timely response to localized symptoms and reduce central line dwell time at a hospital in California, researchers reported.
“Having achieved high-quality [central venous catheters (CVC)] insertion practices as a nation, best-practice maintenance interventions are needed,” Shruti K. Gohil, MD, MPH, associate medical director of epidemiology and infection prevention and assistant professor of infectious diseases at the University of California, Irvine Health, told Infectious Disease News.
“We recognized that although many [central-line–associated bloodstream infection (CLABSI)] prevention strategies exist that address sterile insertion practices or the use of special products — for example, chlorhexidine gluconate-impregnated discs and alcohol-impregnated caps — few strategies address compliance with basic daily practices to prevent infection,” Gohil said. “Specifically, no previously validated strategies existed to identify patients at high risk of infection and intervene before infection develops.”
Gohil and colleagues developed the Central Line Insertion Site Assessment (CLISA) score as a strategy to promote highly attentive processes in assessing, documenting and responding to lines showing signs of overt inflammation or infection that may precede a CLABSI. (Editor’s note: The score is available in a table embedded in the study.)
In a pre- and postintervention, quasi-experimental quality improvement study, they assessed the impact of the CLISA score in adult patients with CVCs hospitalized in an ICU and oncology ward at the University of California, Irvine Medical Center.
According to Gohil and colleagues, implementing the CLISA score reduced the prevalence of lines with local inflammation or infection by 78.2%, ensured that lines with localized symptoms were removed 42.9% faster, and reduced central line dwell time by 37.1% and device utilization ratios by 9%.
Gohil said the score established a common and efficient language to describe exam findings to identify possible local infection at the earliest opportunity and promoted preventive actions such as line removal. She added that having nurses document CLISA scores at each shift and cascading these scores into physician progress notes with required physician responses to high scores transformed communication between health care workers and cultivated a sense of shared decision-making.
“The CLISA score provides an evidence-based, metric-friendly, ‘back-to-basics’ approach that hardwires vigilance in daily monitoring and assessment, ensures communication between health care workers, and facilitates appropriate response,” Gohil concluded. – by Caitlyn Stulpin
Disclosures: Gohil reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.