417. Impact of a Standardized Central Line Insertion Site Assessment (CLISA) Score on Localized Inflammation and Infection
Session: Poster Abstract Session: HAI: Preventing Device-Associated Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Inpatient CLISA Intervention Poster IDSA 10.24.16.pdf (1.0 MB)
  • Background: Progression of locally inflamed/infected insertion sites accounts for nearly 40% of central line-associated bloodstream infections (CLABSIs).  We developed and implemented a central line insertion site assessment score (CLISA) to standardize assessment of insertion sites for early identification of localized infection and prompt timely removal of high-risk lines (Figure 1).

    Methods:  This pre- and post-intervention quality improvement study included inpatients with central lines at an academic medical center. Periodic photo surveys of insertion sites in all eligible patients in oncology and intensive care units was conducted at baseline (4/1/14-3/31/15) and post-intervention (4/1/15-3/31/16) after hospital-wide implementation of (1) electronic nursing documentation of CLISA cascaded into physician electronic progress notes (2) automated alerts prompting documentation and removal of lines with local inflammation/infection (CLISA ≥2). Logistic regression models compared frequency of localized insertion site infection pre- and post-intervention.  Chi-square tests compared hospital CLABSI rates (2014 NHSN criteria).

    Results: We evaluated 402 lines at baseline, including 271 peripherally inserted central catheters (PICCs) and 131 centrally inserted venous catheters (CVCs) and 322 lines post-intervention  (178 PICCs, 140 CVCs). A total of 724 lines with 1763 insertion site assessments were completed. No significant differences were found in line type, site, or unit distribution between baseline and intervention (Table 1).  The number of lines with no/minimal inflammation (CLISA 0-1) and moderate inflammation CLISA 2 did not change significantly (p=0.21 and p=0.6, respectively). Lines with CLISA 3 (severe erythema/purulence) decreased from 40 (10%) to 14 (4%) post-intervention (p<0.01).  CLABSIs decreased from 19 (0.52/1000 line-days) to 13 (0.37/1000 line-days) post-intervention (p=0.42). Device utilization rates were unchanged.

    Conclusion: The CLISA score enabled a programmable primary prevention strategy to standardize insertion site assessment across providers and to decrease localized infections that can progress to CLABSI.

    Shruti K. Gohil, MD, MPH1,2, Jennifer Yim, RN, BSN, CIC3, Kathleen a. Quan, RN, MSN, CIC4, Maurice Espinoza, RN, MSN, CNS, CCRN3, Deborah Thompson, RN, CIC5, Allen P. Kong, MD6, Thomas Tjoa, MPH, MS7, Bardia Bahadori, BA6, Christopher Paiji, BA6, Syma Rashid, MD7, Suzie S. Hong, MS7, Linda Dickey, RN, MPH, CIC2, Mohamad N. Alsharif, MD6, Alpesh N. Amin, MD, MBA, MACP, SFHM, FACC6, Justin Chang, BS7, Usme Khusbu, MA6 and Susan S. Huang, MD, MPH, FIDSA, FSHEA6, (1)Division of Infectious Diseases, Department of Medicine, University of California Irvine, Orange, CA, (2)Epidemiology and Infection Prevention, University of California Irvine Medical Center, Orange, CA, (3)University of California, Irvine Medical Center, Orange, CA, (4)Epidemiology and Infection Prevention Program, University of California Irvine Health, Orange, CA, (5)University of California Irvine Healthcare, Orange, CA, (6)University of California Irvine School of Medicine, Orange, CA, (7)Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA

    Disclosures:

    S. K. Gohil, None

    J. Yim, None

    K. A. Quan, None

    M. Espinoza, None

    D. Thompson, None

    A. P. Kong, None

    T. Tjoa, None

    B. Bahadori, None

    C. Paiji, None

    S. Rashid, Sage Products: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    Clorox: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product

    S. S. Hong, None

    L. Dickey, None

    M. N. Alsharif, None

    A. N. Amin, None

    J. Chang, None

    U. Khusbu, None

    S. S. Huang, Sage Products: Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract) , Participating healthcare facilities in my studies received contributed product
    Molnlycke: Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract) , Participating healthcare facilities in my studies received contributed product
    3M: Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract) , Participating healthcare facilities in my studies received contributed product
    Clorox: Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract) , Participating healthcare facilities in my studies received contributed product

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.