• Australian Council on Healthcare Standards (ACHS). ACHS clinical indicator users' manual 2009. ULTIMO NSW: Australian Council on Healthcare Standards (ACHS); 2009 Jan. 853 p.

Does not apply to this measure

This measure is used to assess the percentage of adult intensive care unit (ICU)-associated centrally-inserted central line-associated blood stream infection (CI-CLAB), during the 6 month time period.

The rate of CLAB for this indicator is expressed per 1000 central line-days and each is calculated and reported separately.

Central line-associated blood stream infections (CLABs) are responsible for 20 to 40% of healthcare-associated blood stream infections. Risks for occurrence differ amongst clinical units dependent 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 blood-stream infections (BSIs) can be used as a measure of the safety of key clinical practice processes within a unit.

As absolute rates of central line-associated infections are in general quite low, it is important for units to realize that unless the line-day denominator for the surveillance period is large, the standard error of an individual rate measurement is high. Suspected infection trends within a unit should therefore 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.

Adult intensive care unit (ICU); centrally-inserted central line-associated blood stream infection (CI-CLAB); central line-days

Total number of centrally-inserted (CI) central line-days in adult intensive care unit (ICU), during the 6 month time period (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Total number of adult intensive care unit (ICU)-associated centrally-inserted central line-associated blood stream infection (CI-CLAB), during the 6 month time period (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

• A formal consensus procedure involving experts in relevant clinical, methodological, and organizational sciences
• One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Use of this measure to improve performance
Variation in quality for the performance measured

• Australian Council on Healthcare Standards (ACHS). Australasian clinical indicator report 2001-2007. Determining the potential to improve quality of care: 9th edition. ULTIMO NSW: Australian Council on Healthcare Standards (ACHS); 2008. 611 p.

Current routine use

Internal quality improvement

Hospitals

Physicians

Single Health Care Delivery Organizations

Adults

Either male or female

Unspecified

See the "Rationale" field.

Unspecified

Unspecified

Unspecified

The 2003 National Strategy to Address Health Care Associated Infections, developed by the Australian Council for Safety and Quality in Health Care, suggests that blood stream infections (BSls) may be costing Australia up to $686 million each year.

• Australian Council on Healthcare Standards (ACHS). ACHS clinical indicator users' manual 2009. ULTIMO NSW: Australian Council on Healthcare Standards (ACHS); 2009 Jan. 853 p.

Getting Better

Effectiveness
Safety

Users of care only

Centrally-inserted (CI) central line-days in adult intensive care unit (ICU), during the 6 month time period (see the "Denominator Inclusions/Exclusions" field)

Patients associated with provider

Inclusions
Total number of centrally-inserted (CI) central line-days in adult intensive care unit (ICU), during the 6 month time period

Notes:

• Central lines are classified as intravascular devices with a tip ending in a major vein or artery in the abdomen or chest.
• In CI central line, the skin entry point is on the trunk of the patient.
• ICU includes any general or speciality (i.e., cardio-thoracic, burns, neurosurgical or coronary care) intensive care unit. ICUs are stratified according to their designation as either adult or paediatric.
• When calculating CI central line days, all types of CI central lines (cuffed and non-cuffed, implanted, etc.) in situ in a specific unit during the time period under study are included. Patients with two CI central lines in place for one day are counted as one CI central line-day.

Exclusions
Unspecified

All cases in the denominator are equally eligible to appear in the numerator

Institutionalization
Therapeutic Intervention

Time window brackets index event

Inclusions
Total number of adult intensive care unit (ICU)-associated centrally-inserted central line-associated blood stream infection (CI-CLAB), during the 6 month time period

Notes:

• Diagnosis of blood stream infection (BSI) must meet specific criteria set out in Appendix 6 of the original measure documentation.
• 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.
• ICU-associated events are CLABs that manifest at least 48 hours after admission to ICU or occur within 48 hours of discharge from ICU.

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Institutionalization

Medical record

Not Individual Case

Adverse Outcome

Unspecified

Rate

Better quality is associated with a lower score

Unspecified

External comparison at a point in time
External comparison of time trends
Internal time comparison

Unspecified

Indicator area 2: central line-associated blood stream infections CI 2.1.

Australian Council on Healthcare Standards

Funding is direct Australian Council on Healthcare Standards (ACHS) funding sourced through our membership. ACHS does not receive external funding from the government or other sources.

Our terms of reference dictate the composition of the working parties that develop our indicators and include the following:

• Two Clinicians -- nominated by the relevant specialty college/association/society, one nominated to be the chair of the working party
• Private Hospital Representative -- nominated by the Australian Private Hospital Association
• Consumer Representative -- nominated by the Consumer Health Forum of Australia
• Coding Representative -- nominated by the National Centre for Clinical classification on Health
• Quality Health New Zealand, nominated by QHNZ (if applicable)
• Epidemiological/Clinical Research Representative, Director of Health Services Research Group, University of Newcastle
• Australian Council on Healthcare Standards (ACHS) Representatives -- Clinical Director, Coordinator, Administrative Assistant
• Other Expert Stakeholders, as required

None

The Australian Council on Healthcare Standards (ACHS) Infection Control Indicators are in accordance with the standard set of definitions published by the Australian Council for Safety and Quality in Health Care's, Health Care Associated Infections Advisory Committee (HCAIAC) and Surveillance Working Party.

The definitions were originally developed by the National Advisory Board of the Australian Infection Control Association based on the National Nosocomial Infections Surveillance Systems, the Nosocomial Infection National Surveillance System and from the Public Health Laboratory Service of the UK (PHLS).

In response to feedback from participating organisations and in keeping with the above definitions, the indicators published as version 3 have been modified to either improve the understanding of the indicator definitions or improve collection methodologies.

2002 Jan

2009 Jan

This is the current release of the measure.

• Australian Council on Healthcare Standards (ACHS). ACHS clinical indicator users' manual 2009. ULTIMO NSW: Australian Council on Healthcare Standards (ACHS); 2009 Jan. 853 p.

This NQMC summary was completed by ECRI Institute on September 11, 2009.

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions. This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission from The Australian Council on Healthcare Standards (ACHS).