How to Collect and Monitor Bloodstream Infection Rates
Contents:
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3)
4)
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8)
CDC Definition of Bloodstream Infections
Sample Policy and Procedure Manual for Insertion of CVC
Central Line Bundle Percent Compliance Calculations
CVC-BSI Numerator / Denominator Definitions and Calculation
Sample Tool for CVC Line Day Collection
Sample Collection Tool for CVC and Ventilator Days
Sample Collection Tool for Device Days
Sample Collection Tool for Device Days
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CDC Definition of Bloodstream Infections
Laboratory-confirmed bloodstream infection must meet at least one of the following criteria:
Criterion 1. Patient has a recognized pathogen cultured from one or more blood cultures and organism
cultured from blood is not related to an infection at another site.
Criterion 2. Patient has at least one of the following signs or symptoms: fever (38 o C), chills, or
hypotension and at least one of the following:
a.
common skin contaminant (e.g., diphtheroids, Bacillus sp., Propionibacteriumsp,
coagulase-negative staphylococci, or micrococci) is cultured from at least two or more
blood cultures drawn on separate occasions
b.
common skin contaminant (e.g., diphtheroids, Bacillus sp., Propionibacteriumsp,
coagulase-negative staphylococci, or micrococci) is cultured from at least one blood
culture from a patient with an intravascular line, and the physician institutes appropriate
antimicrobial therapy
c.
positive antigen test on blood (e.g., H. influenzae, S. pneumoniae, N. meningitides, or
group B Streptococcus) and signs and symptoms and positive laboratory results are not
related to an infection at another site
Criterion 3. Patient < 1 year of age has at least one of the following sign or symptoms: fever
(38oC), hyperthermia (<37oC), apnea, or bradycardia
And at least one of the following:
a.
common skin contaminant (e.g., diphtheroids, Bacillus sp., Propionibacteriumsp,
coagulase-negative staphylococci, or micrococci) is cultured from two or more blood
cultures drawn on separate occasions
b.
common skin contaminant (e.g., diphtheroids, Bacillus sp., Propionibacteriumsp,
coagulase-negative staphylococci, or micrococci) is cultured from at least one blood
culture from a patient with an intravascular line, and physician institutes appropriate
antimicrobial therapy
c.
positive antigen test on blood (e.g., H. influenzae, S. pneumoniae, N. meningitides, or
group B Streptococcus) and signs and symptoms and positive laboratory results are not
related to an infection at another site
REPORTING INSTRUCTIONS:
 Report purulent phlebitis confirmed with a positive semi quantitative culture of a catheter
tip, but with either negative or no blood culture, as CVS-VASC.
 Report organisms cultured from blood as BSI-LCBI when no other site of infection is
evident.
 Pseudobacteremias are not nosocomial infections.
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Sample Medical Staff Policy and Procedure Manual
Policy Number: MS04-2
Page 1 of 3
SUBJECT:
Insertion of Central Venous/ Pulmonary Artery Catheters
PURPOSE:
To reduce the patient’s risk of acquiring an intravascular catheter-related
infection.
POLICY:
1.
When inserting a central venous/pulmonary artery catheter, maximal
sterile barrier precautions are recommended.
2.
Maximal sterile barrier precautions include all of the following:
-sterile gown
-sterile gloves
-mask
-cap
-large sterile drape for establishment of sterile field
3.
These barrier precautions are recommended for all initial central
venous/pulmonary artery catheter placements and during central line
changes over guidewires or to a new site. Catheters included:
A. Nontunneled central venous catheters: Single or multi-lumen catheter
inserted into a central vein (subclavian, internal jugular, or femoral).
B. Pulmonary artery catheters: Inserted through a Teflon introducer in a
central vein (subclavian, internal jugular, or femoral).
C. Peripherally inserted central venous catheters (PICC): Inserted into
basilic, cephalic, or brachial veins and enter the superior vena cava.
D. Peripheral arterial catheters: Usually inserted in radial artery; can be
placed in femoral, axillary, brachial, posterior tibial arteries.
E. Hemodialysis catheters
F. Tunneled central venous catheters: Implanted into subclavian, internal
jugular, or femoral veins.
4.
ChloraPrep (2% chlorhexidine gluconate / 70% isopropyl alcohol) is the
preferred skin antiseptic for catheter insertion and during dressing
changes, although, an iodophor or 70% alcohol can be used if there is
patient sensitivity to chlorhexidine.
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Medical Staff Policy and Procedure Manual
Policy Number: MS04-2
Page 2 of 3
5.
The subclavian site (rather than the jugular or femoral site) in adult
patients is preferred to minimize infection risk for nontunneled central
venous catheter placement, however, other patient considerations may
determine the site selection.
6.
Place catheters for hemodialysis and pheresis in a jugular or femoral vein
rather than a subclavian vein to avoid venous stenosis if catheter access is
needed.
7.
Do not routinely replace central venous catheters, PICCs, hemodialysis
catheters, or pulmonary artery catheters to prevent catheter-related
infections.
8.
When adherence to aseptic technique cannot be ensured (i.e., when
catheters are inserted during a medical emergency), replace all catheters as
soon as possible and after no longer than 48 hours.
9.
Do not routinely culture catheter tips.
Reference:
CDC. Guidelines for the Prevention of Intravascular Catheter-Related Infections. MMWR.
August 9, 2002. Vol. 51, No. RR-10.
Originated: 3/95
Reviewed: 6/97, 3/00, 1/02
Revised:
12/98, 4/04, 7/04, 8/04
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Medical Staff Policy and Procedure Manual
Policy Number: MS04-2
Page 3 of 3
Originated by: Infection Control Committee ___________________________________
Chairperson, Infection Control Committee
Approved by: _______________________________
Date: __________________
Medical Director, Critical Care
_______________________________
Date: __________________
Medical Director, Surgery
________________________________
Date: ___________________
Medical Director, Internal Medicine
________________________________
Date: __________________
President, Medical Staff
________________________________
Date: __________________
Senior Vice President, Operations
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Central Line Bundle Percent Compliance Calculations
Calculation Details:
Numerator Definition: The number of times the bundle practices were completed during
central line insertions.
Denominator Definition: The number of compliance forms that were completed during central
line insertion each month.
Measurement Period: Monthly
EXAMPLES:
You get 10 line insertion checklists back. On 9 of those forms, “full body drapes” are marked as
being used and 1 was marked as not being used. The compliance for “full body drape” usage is
90%. (9 divided by 10 = 90%).
You get 15 line insertion checklists back. On 13 sheets, “Chlorhexidine” is marked as being the
sole skin prep agent. On 2 sheets, Betadine is marked as being used. Compliance for
“Chlorhexidine” usage would be 87% (13/15 = 87%)
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Measurement Information Form:
Central Line-Associated Primary Bloodstream Infection Rate per
1000 Central Line Days
Calculation Details
Numerator Definition: Number of catheter-related bloodstream infections (BSIs) and
laboratory confirmed BSI.
Denominator Definition: Number of central line device days. (A patient who has more than
one line is still counted as one device day)
Definition of Terms:
 Use CDC guidelines (from Appendix A of CDC Guideline MMWR Aug 9, 2002/51 (RR
10); 27-28)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a2.htm
 Central line: A vascular access device that terminates at or close to the heart or one of
the great vessels.
Measurement Period: measure monthly
Calculate as: (Number of catheter-related bloodstream infections and lab confirmed BSI
divided by Number of central line days) X 1000.
Example
If in February there were 12 cases of CR-BSIs, the number of cases would be 12 for that month.
Thus, if 25 patients had central lines during the month and each, for purposes of example, kept
their line for 3 days, the number of catheter days would be 25 x 3 = 75 for February. The CRBSI Rate would be (12/75) x 1000 = 160 per 1000 device days.
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Central Lines
Unit: ____________
Date: ____________
# of Patients
Sunday
___________________
Monday
___________________
Tuesday
___________________
Wednesday
___________________
Thursday
___________________
Friday
___________________
Saturday
___________________
Total:
___________________
Please leave sheet on the unit assignment clipboard for the charge nurse to
complete every morning with the day shift assignment
Count the number of patients each day that have at least one line connected to a
central artery or vein. A patient who has more than one central line at any
given time is still counted as one.
Sheets should be sent to the Infection Control Department at the end of the month.
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VENTILATOR AND CENTRAL VENOUS LINES MONTHLY REPORT
The Infection Control Committee greatly appreciates your help with CVL surveillance. The magnitude of
the potential to cause morbidity and mortality resulting from infectious complications has been well
documented. Treatment of line related infections are estimated to cost between $34,000 to greater than
$56,000 per patient.
INSTRUCTIONS:
 Please document the date and unit in the appropriate blanks following instructions.
 Please count the number of patients with central venous lines every day at the same time and
record the number in the second column.
 A separate column requests the number of patients with catheters for dialysis. Do not include
these in the total number of central lines.
 Please do the same count of the number of patients on the ventilator.
 PLEASE NOTE THE UPDATED DEFINITION OF CENTRAL LINES. PLEASE DO INCLUDE THE
FOLLOWING:
PICC, Long arm Groshong, Broviac, Hickman, IABP, IJ, Portacath, Double or triple lumen catheters
regardless of site and Swan
 Please submit this form to Infection Control by the end of the first week of each month. THANKS!
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Month and Year: _________________________
Date
Total # of Patients
with Central Lines
Total # Patients with
Dialysis Catheters
Unit: ______________
Total # of Patients on
Ventilator
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
TOTAL
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NATIONAL NOSOCOMIAL INFECTIONS SURVEILLANCE SYSTEM
ADULT AND PEDIATRIC INTENSIVE CARE UNIT (ICU) MONTHLY REPORT FORM
NNID# ___________
Month and Year: ______________
Circle type of ICU: Burn
Coronary Care
Respiratory
Surgical
Hospital’s code for this ICU: _________
CardioThoracic
Medical
Trauma
Other (specify): _________________________
Number of patients in ICU . . . . . . . First Day of Month: ___________________
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
TOTAL
# New Arrivals
# Patients
Indwelling urinary catheter
Med/Surg
Neurosurgical
Pedatric
First Day of Next Month: ___________________
Number of Patients with:
Central line(s)
Ventilator
Assurance of Confidentiality: The information obtained in this surveillance system that would permit identification of any individual or institution is collected with a
guarantee that it will be held in strict confidence, will be used only for the purposes stated, and will not otherwise be disclosed or released without the consent of the
individual, or the institution in accordance with Sections 304, 306 and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and m(d)).
Public reporting burden of this collection of information is estimated to average 6 hours per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a
person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate
or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE,
MS D-24, Atlanta, Georgia 30333; ATTN: PRA (0920-0012).
CDC 57.58B REV. 9-00
IDEAS Version 6.06
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May
Sun
1
# pts. with C
lines___
# of vent
pts.______
8
# pts. with C
lines___
# of vent
pts.______
15
# pts. with C
lines___
# of vent
pts.______
22
# pts. with C
lines___
# of vent
pts.______
29
# pts. with C
lines___
# of vent
pts.______
Mon
2
# pts. with C
lines___
# of vent
pts.______
9
# pts. with C
lines___
# of vent
pts.______
16
# pts. with C
lines___
# of vent
pts.______
23
# pts. with C
lines___
# of vent
pts.______
30
# pts. with C
lines___
# of vent
pts.______
Tue
3
# pts. with C
lines___
# of vent
pts.______
10
# pts. with C
lines___
# of vent
pts.______
17
# pts. with C
lines___
# of vent
pts.______
24
# pts. with C
lines___
# of vent
pts.______
Wed
4
# pts. with C
lines___
# of vent
pts.______
11
# pts. with C
lines___
# of vent
pts.______
18
# pts. with C
lines___
# of vent
pts.______
25
# pts. with C
lines___
# of vent
pts.______
Thu
5
# pts. with C
lines___
# of vent
pts.______
12
# pts. with C
lines___
# of vent
pts.______
19
# pts. with C
lines___
# of vent
pts.______
26
# pts. with C
lines___
# of vent
pts.______
Fri
Sat
6
# pts. with C
lines___
# of vent
pts.______
7
# pts. with C
lines___
# of vent
pts.______
13
# pts. with C
lines___
# of vent
pts.______
14
# pts. with C
lines___
# of vent
pts.______
20
# pts. with C
lines___
# of vent
pts.______
21
# pts. with C
lines___
# of vent
pts.______
27
# pts. with C
lines___
# of vent
pts.______
28
# pts. with C
lines___
# of vent
pts.______
31
# pts. with C
lines___
# of vent
pts.______
2005
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