Review CLABSI cases to understand time and location of CLABSI events
Element
Key Institutional Partners
  • Perform audit to understand when CLABSIs occur in your facility
    • Review PICC cases with provider diagnosis of CLABSI, NHSN CLABSI, line sepsis/bacteremia and PICC removal for suspected CLABSI
    • CLABSIs detected within 6 days of line insertion = likely to be related to insertion-related events
    • CLABSIs occurring ≥7 days of line insertion = likely to be related to care and maintenance-related events
QI Team, Vascular Access Team
  • Review CLABSI cases to determine where CLABSIs occur in your facility (ICU vs Non-ICU). Subsequent interventions in this toolkit should be focused on these patient care areas
QI Team, Vascular Access Team
  • Review CLABSI cases using the following tools to assess if the correct device was used and/or number of lumens was appropriate:
    • MAGIC guidelines
    • Michigan PICC CLABSI Score – Predicts Risk of CLABSI
      • If patient was at a high risk of CLABSI, were advanced technologies (i.e. coated catheters, CHG dressings, CHG bathing) used?
QI Team, Vascular Access Team
Resources/Tools
Audit tool to review to review HMS CLABSI cases 
Decision Tools:
Tools to Assist with Determining Potential Vesicants
PICC Tier 1 Resources and Tools 
Articles/References
Chopra V, et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). Annals of Internal Medicine 2015
  • Criteria for the use of PICCs was developed, adopting the RAND/UCLA Appropriateness Method. After a review of 665 scenarios, 43% of PICCs were flagged as inappropriate. Applying these criteria as a guide can help decrease the likelihood of an inappropriate catheter, improve care, and inform quality improvement efforts
Moureau N, et al. Making the MAGIC: Guiding vascular access selection for intensive care - a summary of Michigan Appropriateness Guide for Intravenous Cathters (MAGIC). ICU Management & Practice 2016.
  • MAGIC provides guidance through which to assess the appropriateness of PICCs and other vascular access devices for the intensive care patient. Application of MAGIC by clinicians and providers within intensive care areas may assist hospitals in establishing reliable access, improving outcomes, achieving infection prevention goals and reducing burden of thrombosis
Herc E, et al.  Model to Predict Central-Line-Associated Bloodstream Infection Among Patients With Peripherally Inserted Central Catheters: The MPC Score. Infection Control & Hospital Epidemiology 2017
  • Michigan PICC-CLABSI Score - risk factors for CLABSI in patients with PICC lines include:  hematological cancer, history of CLABSI within 3 months of PICC insertion, multi-lumen PICCs, solid cancers with ongoing chemotherapy, receipt of total parenteral nutrition through the PICC, and the presence of another central venous catheter (CVC)
NHSN/CDC Device Associated Module - Blood Stream Infection Event (Central Line-Associated Bloodstream Infection and Non-central Line Associated Blood Stream Infection).​
Validation Survey
CLABSI Step 1 Validation - Review CLABSI Data. ​
  • This document includes all of the validation questions associated with this content area to help with collaboration on responses for your hospital. Responses to the validation questions should be entered in to the linked document and recorded to monitor progress. 
​Perform an assessment of potential cost savings from preventing PICC-related CLABSI
Element
Key Institutional Partners
  • Perform an assessment of potential cost savings from preventing PICC-related CLABSI
QI Team, Hospital Leadership
Resources/Tools
Articles/References
Decision Tools:
Ratz D, et al. Limiting the number of lumens in peripherally inserted central catheters to improve outcomes and reduce cost:  A simulation study. Infection Control & Hospital Epidemiology 2016
  • Increases in single lumen PICC use resulted in monetary savings and decreases in PICC-associated CLABSI and PICC-associated DVT
Validation Survey
CLABSI Step 1 Validation - Perform an Assessment of Potential Cost Savings. ​
  • This document includes all of the validation questions associated with this content area to help with collaboration on responses for your hospital. Responses to the validation questions should be entered in to the linked document and recorded to monitor progress.