• 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 number of peripherally-inserted (PI) central line-days per patient-days in paediatric intensive care unit (ICU), during the 6 month time period.

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 realise 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.

Paediatric intensive care unit (ICU); peripherally-inserted (PI) central line-utilisation ratio (CLUR)

Total number of patient-days in paediatric intensive care unit (ICU), during the 6 month time period (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Total number of peripherally-inserted (PI) central line-days in paediatric intensive care unit (ICU), 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

Monitoring and planning

• 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

Monitoring and planning

Hospitals

Physicians

Single Health Care Delivery Organizations

Children

Either male or female

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Not within an IOM Care Need

Not within an IOM Domain

Users of care only

Patient-days in paediatric intensive care unit (ICU), during the 6 month time period

Patients associated with provider

Inclusions
Total number of patient-days in paediatric intensive care unit (ICU)*, during the 6 month time period

*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.

Exclusions
Unspecified

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

Institutionalization

Time window brackets index event

Inclusions
Total number of peripherally-inserted (PI) central line-days in paediatric 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.
• A peripherally-inserted (PI) central line is inserted through a limb vein.
• When calculating PI central line days, all types of PI central lines in situ in a specific unit during the time period under study are included. Patients with two PI central lines in place for one day are counted as one PI central line-day.
• Central line-utilisation ratios (CLURs) are calculated for ICUs and provide an indication of the degree to which ICU patients are exposed to the risk of central line-associated blood stream infection (CLAB). It enables ICUs to determine whether their unit is comparable to other similar units in terms of centrally-inserted (CI) and PI central line utilisation.

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

Does not apply to this measure

Unspecified

Rate

Undetermined

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 2.8.

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.

This measure updates a previous version: Australian Council on Healthcare Standards (ACHS). ACHS clinical indicator users' manual 2008. ULTIMO NSW: Australian Council on Healthcare Standards (ACHS); 2007 Dec. 776 p.

• 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 August 11, 2008. This NQMC summary was updated 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).