Central Line Bundle Compliance (NQF 0298)

EMeasure Name Central Line Bundle Compliance EMeasure Id 9ECD3B94-6328-4482-AF59-E7BF7FD8F14D
Version number 1 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
Measurement duration
12 month(s)
Reference
Mermel LA. Prevention of intravascular catheter-related infections. Annals of Internal Medicine. Mar 7 2000;132(5):391-402.
Reference
Soufir L, Timsit JF, Mahe C, Carlet J, Regnier B, Chevret S.  Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study.  Infect Control Hosp Epidemiol. 1999 Jun;20(6):396-401.
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.
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.

The ICU patient with a 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.

Table of Contents


Population criteria

Data criteria (QDS Data Elements)

Summary Calculation

Calculation is generic to all measures:



Measure set CLINICAL QUALITY MEASURE SET 2011-2012