​​Central Line Associated Blood Stream Infection (CLABSI) Prevention

The true incidence of Central Line Associated Blood Stream Infections in Australian ICU is unknown; however the cost in morbidity and health care dollars is high. In 2010, the Australian Commission on Safety and Quality in Health Care (ACSQHC) granted ANZICS funding to lead a project to decrease Australian ICU CLABSI To <1/1000 line days and to facilitate accurate and consistent CLABSI measurement, with timely reporting to clinicians and benchmarking opportunities.  The project was based on successful Australian and international projects which focussed on strict aseptic technique and maximal barrier precautions at the time of central line insertion. Resources for clinicians were developed including an insertion checklist, insertion compliance calculator and comprehensive guidelines for ongoing care. For further information regarding the Prevention Project or CLABSI Prevention please contact the ANZICS Safety and Quality Executive Officer.


ANZICS CORE CLABSI Registry

The ANZICS CORE CLABSI Registry was launched in July 2012 providing a national registry and reporting system enabling ICUs to compare their CLABSI rate against peer units throughout Australia.

In most states data that is being submitted to the CLABSI Registry will be through the state based surveillance bodies with the exception of Northern Territory and Tasmania, where data is being submitted by individual participating ICUs. For further assistance please contact the CORE Manager​.

The CLABSI Registry and User guide is available for download below or from the ​ANZICS CORE Portal​​.

ANZICS CORE CLABSI User Guide 2013.pdf

Resources

ANZICS CLABSI Prevention Project Final Report.pdf

ANZICS Central Line Insertion & Maintenance Guideline_201204.pdf

The ANZICS Central Line Insertion and Maintenance Guideline provides guidance on all aspects of preventing infection during central line insertion and maintenance

ANZICS Central Line Insertion Checklist.pdf

ANZICS Central Line Insertion Checklist.doc

The Insertion Checklist is designed for use at the bedside during central line insertion.  When possible it should be completed by someone who observes the whole procedure, but is not a proceduralist. The observer and assistant will most likely be the same person.

The information on the checklist can be used to calculate compliance with the guidelines, using the compliance calculator. The items in the grey boxes are the essential elements to be considered, however individual ICUs may want to collect the other data as well.

We recommend this data is collected at least three times per year, on all central line insertions for a month, and whenever there is an n increase in the CLAB​SI rate above 1/1000 line days. Some ICUS may wish to collect the data at all times to provide ongoing feedback to staff, especially where there are few lines inserted.

ANZICS Central Line Insertion Compliance Calculator.xls

The Insertion Compliance Calculator spreadsheet will automatically calculate your compliance with each essential element of the checklist, and overall compliance with all elements.

Enter data for each patient on a separate line. Additional lines can be added and the formulae will not be affected.

ANZICS CLABSI Prevention Poster.pdf

ANZICS CLABSI Prevention made easy Postcard.pdf

CLABSI Surveillance​ 

In order to ensure consistency in surveillance the ACSQHC publish the national definition of Central Line Associated Blood Stream Infection Case​ on their website http://www.safetyandquality.gov.au/our-work/healthcare-associated-infection/national-hai-surveillance-initiative/national-definition-and-calculation-of-central-line-associated-blood-stream-infection/

There are two components to CLABSI surveillance – the number of infections (numerator) and the number of line days (denominator).

Infections

We suggest the infections (numerator) be collected in collaboration with Infection Prevention and Control Departments, as they are usually well versed in the surveillance process and may have systems already in place to collect positive blood cultures.

Line Days

There are several ways in which line days can be counted:

  1. By counting the number of days each patient has a central line insitu; this can be labour intensive unless there is a computerised information system in use that can be queried for each specific month.
  2. By counting the number of patients with a central line every day.
  3. If unable to do a count every day
    1. By counting the number of patients with a central line on as many days as possible and add together
    2. Divide the total number of lines by the number of days on which the count was done
    3. Multiply by the number of days in that month.

If using system 3, the count should be done at least Monday, Wednesday and Friday. If any of these days area a public holiday, a count should be done on the day before or after. Ideally, the count should be done at the same time each day.

The weekly Line-day Count Tool is designed for use by the person who physically performs the count; it can be adapted to suit different sized units, and can be used without any technical or nursing knowledge.

ANZICS weekly central line-day count.doc

CLABSI Rate

If you would like to calculate your CLABSI rate:

  • Enter the daily line count in each month: only enter 0 if there were no lines in situ that day; if you didn't count that day leave blank
  • Enter the number of infections into the numerator sheet and the CLABSI rate will automatically be calculated.

Useful Links​

Australian Commission on Safety and Quality in Healthcare http://www.safetyandquality.gov.au

Hand Hygiene Australia http://www.hha.org.au/home

Agency for Clinical Innovation (ACI) http://www.aci.health.nsw.gov.au

ACI Intensive Care Coordination and Monitoring Unit (ICCMU) http://www.aci.health.nsw.gov.au/networks/intensive-care

Clinical Excellence Commission (NSW)  http://www.cec.health.nsw.gov.au

Queensland Health Centre for Healthcare Related Infection Surveillance and Prevention https://www.health.qld.gov.au/chrisp/default.asp

Tasmanian Infection and Prevention and Control Unit (TIPCU) http://www.dhhs.tas.gov.au/publichealth/tasmanian_infection_prevention_and_control_unit

Victorian Healthcare Associated Infection Surveillance System (VICNISS) https://www.vicniss.org.au

National Health Service http://www.nhs.uk/

Center for Disease Control and Prevention (CDC) http://www.cdc.gov

CDC National Healthcare Safety Network (NHSN) http://www.cdc.gov/nhsn/about-nhsn/index

CDC's Guidelines for the Prevention of Intravascular Catheter-Related Infections http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf

CDC Patient Safety Manual

Institute for Healthcare Improvement http://www.ihi.org