Haematology and Oncology and Outpatient IV Unit Central lineassociated Bloodstream Infections
ACHS Clinical Indicator Set Version 3
Rationale:
Central line-associated bloodstream (CLAB) infections are responsible for 20-40% of
healthcare-associated bloodstream infections. Risks for occurrence differ among clinical
units depending on the type of line used and patient intrinsic factors. A significant
proportion of CLAB events are preventable through adoption of best clinical practice. The
occurrence of healthcare-associated bloodstream infections (BSI) can be used as a
measure of the safety of key clinical practice processes within a unit.
Suspected infection trends within a unit should be carefully examined by appropriate
statistical measures such as process control charts and other quality improvement tools
to evaluate significance, at time intervals also determined by statistical considerations.
Timely investigation of significantly higher than expected numbers of events or in larger
units, rates of infection, may identify system issues relating to preventative factors for
documentation and corrective action.
Definitions of
Terms:

Diagnosis of BSI must meet specific criteria set out in Appendix 3.

CLAB is defined as a BSI with no other apparent focus of infection where a central
line has been in situ within 48 hours of the event. Note that where a patient has a
peripheral IV or arterial cannula(e) in addition to a central line(s), unless there is
direct evidence of local sepsis at the peripheral site, the central line becomes
associated with the blood event.

Central lines are classified as intravascular devices with a tip ending in a major vein
or artery (ie SVC, IVC, Aorta). Central lines are classified as either ‘centrally
inserted’ in which case the skin entry point is on the trunk of the patient or
‘peripherally-inserted’ where the line inserted through a limb vein. These indicator
definitions stratify infections by insertion site (central or peripheral) in view of the
significant differences between infection rates related to these line types. Within the
category of centrally-inserted lines, there is also a lesser variation in infection rate
according to type of line. In the event that a centrally-inserted CLAB rate is higher
than expected or rising, it is advisable for units to stratify their data further in order to
examine the relative contribution of implanted, tunnelled or non-tunnelled central
catheters to the measured infection rate.

healthcare associated CLAB events that occur in inpatient and outpatients are
counted.

The combined service indicators are used where the Haematology and Oncology
patients are managed by the same Clinical Service (i.e. a combined Haematology &
Oncology Unit).

For collection of line-day denominators for these Units, it is recommended that all
Unit patients have central line insertions and removals tracked individually on a
dedicated database. This enables calculation of central line day denominators with
ease. Example databases will be made available on the NSW Health website.
Type of
Indicator:
These are comparative rate based indicators addressing the outcome of patient care in
terms of infection. Comparisons can be conducted intra-healthcare (within healthcare)
facilities. However, the rate for the present period under study may also be compared
with data presented in the ACHS Comparative Report and the previous study period.
The aim of the suggested comparisons is to reduce your organisations rate to the
comparative rate, or to that of the previous study period, which ever is the lowest.
Calculation
See below for instructions on calculation for these indicators.
It is recommended that a 95% confidence interval is expressed around the rate 1.
1
See Appendix 5 for instructions on calculation of 95% Confidence Intervals.
INDICATOR DATA FORMAT:
CI. 2.9
Numerator
The total number of Haematology Unit-related (inpatient &
outpatient), CI CLAB, during the time period under study.
Denominator
The total number of CI central line-days in Haematology Units
(inpatient & outpatient), during the time period under study.
Numerator
The total number of Haematology Unit-related (inpatient &
outpatient), PI CLAB, during the time period under study.
Denominator
The total number of PI central line-days in Haematology Units
(inpatient & outpatient), during the time period under study.
Numerator
The total number of Oncology Unit-related (inpatient & outpatient),
CI CLAB, during the time period under study.
Denominator
The total number of CI central line-days in the Oncology Unit
(inpatient & outpatient), during the time period under study.
Numerator
The total number of Oncology Unit-related (inpatient & outpatient),
PI CLAB, during the time period under study.
Denominator
The total number of PI central line-days in the Oncology Unit
(inpatient & outpatient), during the time period under study.
Numerator
The total number of Haematology / Oncology Unit-related (inpatient
& outpatient), CI CLAB, during the time period under study.
Denominator
The total number of CI central line-days in the Haematology /
Oncology (inpatient & outpatient), during the time period under
study.
Numerator
The total number of Haematology / Oncology Unit-related (inpatient
& outpatient), PI CLAB, during the time period under study.
Denominator
The total number of PI central line-days in the Haematology /
Oncology Unit (inpatient & outpatient), during the time period under
study.
Haematology
related CI CLAB
rate
CI. 2.10
Haematology
related PI CLAB
rate
CI. 2.11
Oncology
related CI CLAB
rate
CI. 2.12
Oncology
related PI CLAB
rate
CI. 2.13
Haematology /
Oncology
related CI CLAB
rate
CI. 2.14
Haematology /
Oncology
related PI CLAB
rate
CI. 2.15
Numerator
The total number of OPAT Unit-related CI CLAB, during the time
period under study.
Denominator
The total number of CI central line-days in the OPAT Unit, during the
time period under study.
Numerator
The total number of OPAT Unit-related PI CLAB, during the time
period under study.
Denominator
The total number of PI central line-days in the OPAT Unit, during the
time period under study.
Outpatient
Intravenous Unit
(OPAT) – related
CI CLAB rate
CI. 2.16
Outpatient
Intravenous Unit
(OPAT) - related
PI CLAB rate