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Overview

Updated on August 26, 2014

Issue

A central line is a long, hollow tube that is inserted through the chest and into a large vein that sits just above the heart to deliver treatments such as chemotherapy, blood transfusions, antibiotics and intravenous fluids. Patients who require central lines are often critically ill and the development of an infection can prolong hospital stay and be life threatening.1 Central line Infections (CLIs) are of significant concern for health care providers, because this type of infection carries a high mortality rate.1

Call to Action

Although the number of CLIs has shown major improvement with the rate falling to 0.48 infections per 1000 central line days by the end of 2011, there is still room to do better.2

The target for CLIs is zero for all hospitals in Ontario.

  1. Safer Healthcare Now! Prevent Central Line Infection Getting Started Kit.

    Safer Healthcare Now!; 2012 Jun [cited 2012 Nov 15].
    Available from: http://www.saferhealthcarenow.ca/EN/Interventions/CLI/Documents/CLI Getting Started Kit.pdf

  2. Health Quality Ontario. Quality Monitor 2012.

    Toronto: Health Quality Ontario; 2012 Sept [cited 2012 Nov 15].
    Available from: http://www.hqontario.ca/portals/0/Documents/pr/qmonitor-full-report-2012-en.pdf

Best Practices

Updated on August 26, 2014

“Insanity is doing things the way we’ve always done them and expecting different results”
Albert Einstein

Evidence-informed best practices are based on quality evidence and should be implemented into practice to optimize outcomes.6 Listed below you will find best practices graded according to the type of evidence. To view a description of the types of evidence, click here.

To help you move from best evidence to best practice, click on the + button next to each best practice to find details on how to implement, as well as change ideas to test using a PDSA approach. 

Change ideas are specific and practical changes informed by experience and research that focus on improving specific aspects of a system, process or behaviour. To learn more about change ideas see the QI: Getting Started tab.

  1. Safer Healthcare Now! Prevent Central Line Infection Getting Started Kit.

    Safer Healthcare Now!; 2012 Jun [cited 2012 Nov 15].
    Available from: http://www.saferhealthcarenow.ca/EN/Interventions/CLI/Documents/CLI Getting Started Kit.pdf

  2. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care.

    Lancet. 2003 Oct 11;362(9391):1225-30.
    Available from: http://www.ncbi.nlm.nih.gov/pubmed/14568747

  3. Provincial Infectious Diseases Advisory Committee. Best Practices for Hand Hygiene in All Health Care Settings.

    Ministry of Health and Long-Term Care; 2010 Dec [cited 2012 Nov 7]
    Available from: http://www.publichealthontario.ca/en/eRepository/2010-12 BP Hand Hygiene.pdf

Measurement

Updated on August 26, 2014

“Some is not a number, soon is not a time.”
Don Berwick, fomer CEO and President of IHI, December 2004, at launch of the 100,000 Lives Campaign

How will we know if a change is an improvement? Measurement is one of the critical steps in a quality improvement (QI) initiative that assesses the impact of your tests of change. Quality indicators are used to measure how well something is performing. There are three types of quality indicators used to measure your QI efforts: outcome (indicators that capture clinical outcomes and or system performance), process (indicators that track the processes that measure whether the system is working as planned), and balancing indicators (indicators that ensure that changing one part of the system does not cause new problems in other parts of the system).

Key Measurement Guidelines 
  • Choose measures that support the team’s aim statement
  • Consider qualitative and quantitative measures
  • Use existing data collection systems, whenever possible
  • Integrate measurement into the daily routine
  • Use a set of five to seven measures to track progress throughout your QI project

Suggested measures for QI initiatives in venous thromboembolism are listed in the table below:7

Type of Measure Measure
Outcome Measure Rate of central line blood stream infections per 1,000 central line days  (Numerator: Total number of newly diagnosed central line infection cases in the ICU after at least 48 hours of being placed on a central line; Denominator: 1,000 central line days)
Process Measure Central Line-Associated Insertion Bundle Compliance
Process Measure Central Line Maintenance Bundle Compliance
  1. Safer Healthcare Now! Central Line-Associated Bloodstream Infection: Measures [Internet].

    Safer Healthcare Now!; [cited 2012 Nov 7].
    Available from: http://www.saferhealthcarenow.ca/EN/Interventions/CLI/Pages/measurement.aspx

Tools & Resources

Updated on August 26, 2014

Tools

Central Line Infections
QI Tools

 

 

For a more comprehensive list of tools and resources, visit the following links on our HQO website:    

 

 

 

Resources

Central Line Infections
QI Resources