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

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.

Insertion site inflammation was associated with central-line–associated bloodstream infections at a tertiary-care center, 2015–2018

“…Because ISI documentation was unsupervised, our ISI definition may not be implementable across multiple settings. A prospective standardized ISI definition is needed, such as the one proposed by Gohil et al 6 Sensitivity analyses were performed with and without erythema and/or discharge in the ISI definition and results remained similar. However, this unsupervised approach was able to prove an association between ISI and CLABSI and allowed automated monitoring of ISI in parallel to CLABSI prevention efforts and CLABSI incidence.…”

“…Monitoring ISI incidence as a parameter of CLABSI prevention strategies might be helpful depending on CLABSI microbiology data in each institution. Gohil et al 6 designed a central-line insertion site assessment scoring system to standardize the evaluation of local signs of inflammation and identify central-lines at risk for CLABSI. 6 However, they were unable to show an association with CLABSI perhaps due to the power of the study or their low CLABSI rates at baseline.…”

“…The Society of Healthcare Epidemiology of America Compendium does not recommend central-line insertion site assessment surveillance. 7 Gohil et al 6 showed that ISI surveillance was associated with ISI incidence reduction and increased compliance with timely central-line removal. They implemented an ISI scoring system with automated EHR notification to providers.…”

“…Gohil et al 6 prospectively used ISI standardized definitions applied by frontline staff to daily central-line assessments. Standardizing ISI definitions is helpful for comparing ISI trends over time and between institutions.…”

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

“…1). 22 – 24 We sought to assess whether directed attention to line insertion sites using a standardized nursing-physician score could improve central-line care, reduce local and systemic infection, and/or prompt proactive removal of symptomatic lines.…”