Impact of a Central-Line Insertion Site Assessment (CLISA) score on localized insertion site infection to prevent central-line–associated bloodstream infection (CLABSI). (8th November 2019)

• Record Type: Journal Article
• Authors: Gohil, Shruti K.; Yim, Jennifer; Quan, Kathleen; Espinoza, Maurice; Thompson, Deborah J.; Kong, Allen P.; Bahadori, Bardia; Tjoa, Tom; Paiji, Chris; Rudkin, Scott; Rashid, Syma; Hong, Suzie S.; Dickey, Linda; Alsharif, Mohamad N.; Wilson, William C.; Amin, Alpesh N.; Chang, Justin; Khusbu, Usme; Huang, Susan S.
• Is Part Of: Infection control and hospital epidemiology. Volume 41:Number 1(2020)
• Page Start: 59
• Page End: 66
• Publication Date: 2019-11-08
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2019.291
• Languages: English
• ISSNs: 0899-823X

Abstract

Abstract: Objective: To assess the impact of a newly developed Central-Line Insertion Site Assessment (CLISA) score on the incidence of local inflammation or infection for CLABSI prevention. Design: A pre- and postintervention, quasi-experimental quality improvement study. Setting and participants: Adult inpatients with central venous catheters (CVCs) hospitalized in an intensive care unit or oncology ward at a large academic medical center. Methods: We evaluated CLISA score impact on insertion site inflammation and infection (CLISA score of 2 or 3) incidence in the baseline period (June 2014–January 2015) and the intervention period (April 2015–October 2017) using interrupted times series and generalized linear mixed-effects multivariable analyses. These were run separately for days-to-line removal from identification of a CLISA score of 2 or 3. CLISA score interrater reliability and photo quiz results were evaluated. Results: Among 6, 957 CVCs assessed 40, 846 times, percentage of lines with CLISA score of 2 or 3 in the baseline and intervention periods decreased by 78.2% (from 22.0% to 4.7%), with a significant immediate decrease in the time-series analysis ( P < .001). According to the multivariable regression, the intervention was associated with lower percentage of lines with a CLISA score of 2 or 3, after adjusting for age, gender, CVC body location, and hospital unit (odds ratio, 0.15; 95% confidence interval, 0.06–0.34; P < .001). According to the multivariate regression, days to removal of lines with CLISA score of 2 or 3 was 3.19 days faster after the intervention ( P < .001). Also, line dwell time decreased 37.1% from a mean of 14 days (standard deviation [SD], 10.6) to 8.8 days (SD, 9.0) ( P < .001). Device utilization ratios decreased 9% from 0.64 (SD, 0.08) to 0.58 (SD, 0.06) ( P = .039). Conclusions: The CLISA score creates a common language for assessing line infection risk and successfully promotes high compliance with best practices in timely line removal.