Preventing CLABSI

Central line-associated bloodstream infections (CLABSIs) are the third most frequent healthcare-associated infection (HAI) reported to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN), with over 30,000 CLABSIs occurring each year.^1,2 These infections have mortality rates as high as 25 percent and add billions of dollars to the cost of healthcare. Many of these infections are preventable when providers adhere to fundamental infection control principles.

The guidance in The Flash section below explores device utilization at the facility and unit level, explains how NHSN data can be used to target units with higher incidence of infection, and shares tools that assess factors that contribute to increases in CLABSI events.

HSAG HQIC certified infection preventionists are available to assist if you have any questions or need additional support. You can contact them through your Quality Advisor or email HospitalQuality@hsag.com. 

CLABSI Rates

Data show that the CLABSI rate and CLABSI Standardized Infection Ratio (SIR) have worsened since the baseline period of 2019, while CLABSI Standardized Utilization Ratio (SUR) has remained the same (lower rates are better).

Visit the HSAG HQIC Quality Improvement Innovation Portal (QIIP) to view your CLABSI data by selecting the Measure category of HAI–Device-Associated and Measure of CLABSI Rate–All Reported, CLABSI SIR–All Reported, and CLABSI SUR–All Reported.   

Source: NHSN, valid as of 08/25/2023. For additional details on measure specifications, please reference the HSAG HQIC Compendium of Measures. The baseline time period is 01/01/2019–12/31/2019 and current time period is 08/01/2022–07/31/2023.

HSAG HQIC Targeted Assessment for Prevention (TAP) Strategy

This handout displays an easy-to-understand overview of TAP, with a framework for quality improvement that uses data for action to prevent HAIs.

Workplace Violence in Healthcare

The Occupational Safety and Health Administration (OSHA) defines workplace violence “as any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at work.”³ Workplace violence is concerning and poses a constant threat to healthcare workers,⁴ who are at higher risk for workplace violence due to dealing with overstressed people.⁵

Nurses are notably at risk because of their frontline position and persistent contact with patients and families.⁶ There are approximately 57 nurses assaulted daily in the U.S.—that’s two nurses every hour.⁷

Unfortunately, workplace violence is underreported as a result of a widely held belief that it is a part of the profession.⁸ According to a 2021 American Federation of Labor and Congress of Industrial Organizations report on worker safety, rates of workplace violence in healthcare and social assistance settings have almost doubled since 2010.⁸ The following workplace violence prevention strategies may be helpful.  

American Hospital Association (AHA)

Violence Prevention Toolkit

Hospital Quality Institute (HQI)

Workplace Violence in Hospitals

Joint Commission

Checklist of Suggested Strategies for Workplace Violence on Hospital Units

Commure Strongline

Safe Healing Environments: Addressing Workplace Violence in Healthcare Through Legislation, Prevention, and Strategic Solutions

Care Coordination

Quickinar Series

Continue your care coordination journey for managing avoidable hospital readmissions by registering for these short, 30-minute webinars (quickinars)—offered monthly, through May 2024. Find details and recordings for past presentations on the webpage.

1st Tuesdays. Next: January 9, 2024 | 2–2:30 p.m. ET (11 a.m. PT)

Emergency Preparedness Plan (EPP) Webinars

These short, 45-minute webinars discuss key areas for a successful EPP, followed by a Q&A session. Presentations cover up-to-date information/resources and areas of focus included in a comprehensive EPP.

Hosted by HSAG, in partnership with the California Association of Health Facilities (CAHF), Arizona Coalition for Healthcare Emergency Response (AzCHER), California Hospital Association (CHA), California Long-Term Care Ombudsman, the California Department of Public Health (CDPH), local health departments, the California Association of Long Term Care Medicine (CALTCM), and others.

3rd Wednesdays. Next: October 18, 2023 | 6–6:45 p.m. ET (3 p.m. PT)

Find on-demand quickinar recordings, slides, and podcasts for past HSAG HQIC learning series.

Health Equity Quickinar Series

This series addresses the many facets and criteria for hospitals to meet the new Centers for Medicare & Medicaid Services (CMS) Hospital Commitment to Health Equity Structural Measure and Social Drivers Screening Measures.

Patient/Family Engagement (PFE) Quickinar Series

This series addresses the CMS 5 Metrics for PFE and provides facilities a framework to engage patients and families in their care.

Quality and Safety Quickinar Series

Find resources to assist your quality improvement journey, from planning and preparation to sustaining your organization's gains.

References

Woodward B, Umberger R. (2016) Review of best practices for CLABSI prevention and the impact of recent legislation of CLABSI reporting. Sage. https://journals.sagepub.com/doi/full/10.1177/2158244016677747

2 National Healthcare Safety Network. (2023) Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-central Line Associated Bloodstream Infection). https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf

3 Lim M C, Jeffree M S, Saupin S S, Giloi N, Lukman K A. Workplace violence in healthcare settings: The risk factors, implications and collaborative preventive measures. Ann Med Surg. (2022). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9206999/

4 Somani R, Muntaner C, Hillan E, Velonis A, Smith P. A systematic review: effectiveness of interventions to de-escalate workplace violence against nurses in healthcare settings. Safety and Health at Work. (2021). https://www.sciencedirect.com/science/article/pii/S2093791121000354

5 Edward K L, Ousey K, Warelow P, Lui S. Nursing and aggression in the workplace: a systematic review. Br J Nurse Mark Allen Publ. (2013). https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2014.23.12.653

6 Kowalenko T, Gates D, Gillespie G L, Succop P, Mentzel T K. Prospective study of violence against ED workers. Am J Emerg Med. (2013). https://www.sciencedirect.com/science/article/abs/pii/S0735675712003695

7 Putka, S. Violence against nurses worse than ever, analysis finds. Medpage Today. (2022). https://www.medpagetoday.com/special-reports/features/100679

8 Boafo I M. The effects of workplace respect and violence on nurses’ job satisfaction in Ghana: a cross-sectional survey. Hum Resour Health. (2018). https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-018-0269-9

This material was prepared by Health Services Advisory Group (HSAG), a Hospital Quality Improvement Contractor (HQIC) under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication No XS-HQIC-XT-10042023-01