11 measures Antibiotic

Stewardship• #66: Pharyngitis patients

given an abx who had strep test performed

• #91: Patients with Otitis Externa given a topical abx

• #93: Patients with Otitis Externa not given a systemic abx

• #116: 18-64 y/o with bronchitis not given abxwithin 3 days of encounter

Choosing Wisely:Head CT Utilization

• #416: 2-17 y/o with appropriate head CT for blunt head trauma (PECARN rules)

• #415: 18+ y/o with appropriate head CT ordering for blunt head trauma

PregnancyMeasures

• #254: US localization of pregnancy in pregnant pts with abd pain

• #255: Rhogam for Rh negative patients at risk

Miscellaneous

• #54: EKG for non-traumatic chest pain

• #76: Proper sterile technique for CVC placement

• #317: BP Screening and follow up documented

#76 Prevention of Central Venous

Catheter (CVC) - Related Bloodstream Infections

Week 3

#76:Prevention of CVC Related Bloodstream Infections

1. CVC line infections or CLABSIs (Central Line Associated Bloodstream Infections) are costly, increase patient length of stay, and are part of the HAC (Hospital-Acquired Condition) Reduction Program by CMS with resultant penalties for poorly performing hospitals.

2. Following proper guidelines for insertion of CVCs decreases the risk of infection by 50% or greater.

#76:Inclusion

Numerator (following elements documented):• Maximal sterile barrier technique• Hand hygiene• Sterile gloves• If used, Sterile ultrasound technique

followed

Denominator:• All patients regardless of age with CVC

placement.

#76:Specifics

Maximal Sterile Barrier Technique (all of the following)• Cap• Mask• Gown with full sleeves• Sterile gloves• Full body drape of patient

Hand Hygiene (either)• Washing with conventional soap and water• Alcohol based scrubs

Skin Preparation• Chlorhexidine preferred (>0.5% with

alcohol)

Ultrasound (if used)• Sterile probe covers and sterile gel

#76:Skin Preparation

• For skin prep, Chlorhexidine-based solutions (>0.5%) are superior to povidone-iodine solutions (decreased infection risk 50% vs povidone-iodine) and are preferred

• If contraindication to Chlorhexidine, tincture of iodine, povidone-iodine, or 70% alcohol may be used

#76.Exclusion

Only Exclusion:Emergent Line Placement

Documented

Best PracticesAs always, documentation is the key!

Best practice is to clearly state that all 4 aspects (or 3 if ultrasound not used) of CVC insertion:1. “Placement of central venous catheter performed using maximal sterile barrier technique, proper hand hygiene, proper skin

preparation, and sterile ultrasound technique followed.”

2. “Placement of central venous catheter performed using maximal sterile barrier technique (cap, mask, full length sterile gown, sterile gloves, and sterile full body patient drape), hand hygiene (with soap and water), skin preparation (with chlorhexidine), and sterile ultrasound technique (with sterile gel and sterile probe cover) followed.”

3. “Emergent nature of procedure precluded full sterile precautions for CVC placement.”

Not Acceptable:1. “CVC placed with full sterile technique.”

2. “Placement of central venous catheter performed using maximal sterile barrier technique, proper hand hygiene, and sterile ultrasound technique followed.” (1 of the required 4 elements missing.)

3. No reason given.