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A draft guidance document by the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee recommended three process measures for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.


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).


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.


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.