Three process measures include line insertion

Surgical prophylaxis, flu vaccinations

A draft guidance document by the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee recommended three process measures for mandatory public reporting systems on health care-associated infections.

The draft lists the following details on the two selections, including measures, rationale of inclusion, and potential limitations:

1. Central line insertion (CLI) practices.

Measures:

Two measures (expressed as a percentage).

Numerators: Number of CLI in which:

A. Maximal sterile barrier precautions were used
B. Chlorhexidine gluconate (preferred), tincture of iodine, an iodophor, or 70% alcohol used as skin antiseptic.

Denominator: Number of CLIs.

Rationale for Inclusion:

  • Unambiguous target goal (100%).
  • Risk-adjustment is unnecessary.
  • Proven prevention effectiveness: Use of maximal barrier precautions during insertion and chlorhexidine skin antisepsis have been shown to be associated with an 84% and 49% reduction in central line-associated bloodstream infection rates, respectively.

Potential Limitations:

  • Methods for data collection not yet standardized.
  • Manual data collection likely to be tedious and labor-intensive, and data are not included in medical records.

2. Surgical antimicrobial prophylaxis (AMP).

Measures:

Three measures (expressed as a percentage):

Numerators: Number of surgical patients:

A. Who received AMP within 1 hour prior to surgical incision (or 2 hours if receiving vancomycin or a fluoroquinolone).
B. Who received AMP recommended for their surgical procedure.
C. Whose prophylactic antibiotics were discontinued within 24 hours after surgery end time.

Denominator: All selected surgical patients.

Rationale for Inclusion:

  • Unambiguous target goal (100%).
  • Risk-adjustment is unnecessary.
  • Proven prevention effectiveness: Administering the appropriate antimicrobial agent within 1 hour before the incision has been shown to reduce surgical site infections (SSIs). Prolonged duration of surgical prophylaxis (>24 hrs) has been associated with increased risk of antimicrobial-resistant SSI.

Potential Limitations:

Manual data collection may be tedious and labor intensive, but data can be abstracted from medical records.

3. Influenza vaccination of patients and health care personnel.

Measures:

Two measures (each expressed as a percentage of coverage).

Numerators: Number of influenza vaccinations given to eligible patients or health care personnel.

Denominators: Number of patients or health care personnel eligible for influenza vaccine.

Rationale for inclusion:

  • Proven prevention effectiveness: Vaccination of high-risk patients and health care personnel has been shown to be effective in preventing influenza.

Potential limitations:

  • Manual data collection may be tedious and labor-intensive.