Central Line Bundle Compliance (NQF 0298)

eMeasure Name Central Line Bundle Compliance eMeasure Id 9ECD3B94-6328-4482-AF59-E7BF7FD8F14D
Version number 1 eMeasure Set Id D776251C-29FA-4F53-BA52-106279B05D1F
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Institute for Healthcare Improvement
Endorsed by National Quality Forum
Description The percentage of intensive care patients in the included ICUs with central lines for who all five elements of the central line "bundle" are documented on the daily goals sheet, central line checklist, patient"s medical record, or other documentation tool.
Copyright
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Central venous catheters (CVCs) are being increasingly used in the inpatient and outpatient settings to provide long-term venous access.  CVCs disrupt the integrity of the skin, making infection with bacteria and/or fungi possible.  Infection may spread to the bloodstream (bacteremia) and hemodynamic changes and organ dysfunction (severe sepsis) may ensue possibly leading to death.  Approximately 90 percent of the catheter-related bloodstream infections (BSIs) occur with CVCs. 

Forty-eight percent of ICU patients have central venous catheters, accounting for 15 million central venous catheter-days per year in ICUs.  Studies of catheter-related bloodstream infections that control for the underlying severity of illness suggest that attributable mortality for these infections is between 4 and 20 percent.  Thus, it is estimated that between 500 and 4,000 US patients die annually due to bloodstream infections. 

In addition, nosocomial bloodstream infections prolong hospitalization by a mean of 7 days.  Estimates of attributable cost per bloodstream infection are estimated to be between $3,700 to $29,000.
Clinical Recommendation Statement
Care bundles, in general, are groupings of best practices with respect to a disease process that individually improve care, but when applied together result in substantially greater improvement.  The science supporting the bundle components is sufficiently established to be considered standard of care.

The Central Line Bundle is a group of evidence-based interventions for patients with intravascular central catheters that, when implemented together, result in better outcomes than when implemented individually.
Improvement notation
No information
Measurement duration
12 month(s)
Reference
Cherry, R. A., C. E. West, et al. (2011). "Reduction of central venous catheter associated blood stream infections following implementation of a resident oversight and credentialing policy." Patient Saf Surg 5(1): 15.
Reference
Dixon, J. M. and R. L. Carver (2010). "Daily chlorohexidine gluconate bathing with impregnated cloths results in statistically significant reduction in central line-associated bloodstream infections." Am J Infect Control 38(10): 817-821.
Reference
Lin, D. M., K. Weeks, et al. (2011). "Eradicating Central Line-Associated Bloodstream Infections Statewide: The Hawaii Experience." Am J Med Qual.
Definition
Central Line: A vascular access device that terminates at or close to the heart or one of the great vessels, i.e., aorta, superior vena and inferior vena cava, brachiocephalic veins, internal jugular veins, and subclavian veins. An umbilical artery or vein catheter is considered a central line. Note: Neither the location of the insertion site nor the type of device may be used solely to determine whether the line qualifies as a "central" line. Only if the location of the tip of the line meets the criteria above does the device qualify as a central line.

Great Vessels: Aorta, superior vena and inferior vena cava, braciocephalic veins, internal jugular veins, and subclavian veins.
Definition
Initial Patient Population(s): All patients with central lines in ICU >= 18 years of age at the date of ICU admission. This measure is divided into two populations to differentiate elements of the central line bundle required at the time of central line insertion (Population 1) from those required on each subsequent day (Population 2).
Definition
Denominator(s): Total number of intensive care patients with central lines.  The denominator for Population 2 specifies all patients for whom central lines remain in place at least 1 day after they are inserted.
Definition
Denominator Exclusion(s): As only patients >= 18 years of age are included in the population, not exclusion logic is added
Definition
Numerator(s): Number of intensive care patients with central lines for whom all elements of the central line bundle are documented and in place. The numerator for Population 1 includes criteria for bundle elements required at the time of central line insertion. The numerator for Population 2 includes criteria for bundle elements required daily starting with the first day after central line insertion (each central line must be assessed daily and a central line care protocol must be followed).
Definition
Denominator Exception(s): Patients for whom bundle elements are contraindicated
Guidance
This is an "all or nothing" measure. If any of the elements are not documented, do not count the patient in the numerator. If a bundle element is contraindicated for a particular patient and this is documented appropriately in the medical record, then the bundle can still be considered compliant with regard to that element.

For central line placement, in adults, avoidance of the femoral vein is preferred as it is associated with greater risk of infection. The subclavian line site may be preferred over the jugular site for non-tunneled catheters in adult patients. This recommendation is based solely on the likelihood of reducing infectious complications.

This measure is divided into two population.  The first numerator sets criteria for all elements that must be present at the time of central line insertion.  The second numerator sets criteria for all the elements that must be present each day subsequent to insertion: each ICU patient with a central line must have the central line  assessed daily using a  central line care protocol and each central line will be reviewed daily, with a notation on the daily goals sheet or medical record indicating the continued need for the central line. Routine replacement should be avoided, and all lines should be removed as early as possible.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

      ------ Population Criteria 1 ------

      ------ Population Criteria 2 ------

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012