Skip to main content

The AHRQ National Quality Measures Clearinghouse (NQMC, qualitymeasures.ahrq.gov) Web site will not be available after July 16, 2018 because federal funding
through AHRQ will no longer be available to support the NQMC as of that date. For additional information, read our full announcement.
  • Measure Summary
  • NQMC:010662
  • Oct 2015
  • NQF-Endorsed Measure

Perioperative care: percentage of patients, regardless of age, who undergo central venous catheter (CVC) insertion for whom CVC was inserted with all elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed.

American Society of Anesthesiologists (ASA). Prevention of central venous catheter (CVC)-related bloodstream infections. Schaumburg (IL): American Society of Anesthesiologists (ASA); 2015 Oct 1. 2 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

This measure updates a previous version: American Society of Anesthesiologists, Physician Consortium for Performance Improvement®. Anesthesiology and critical care physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2008 Oct. 21 p. [5 references]

Measure Hierarchy

Perioperative Care

Age Group

UMLS Concepts (what is this?)

SNOMEDCT_US

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients, regardless of age, who undergo central venous catheter (CVC) insertion for whom CVC was inserted with all elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed.

Rationale

Catheter-related bloodstream infection is a costly complication of central venous catheter (CVC) insertion, but may be avoided with routine use of aseptic technique during catheter insertion. This measure is constructed to require that all of the listed elements of aseptic technique are followed and documented. Hospital-acquired bloodstream infections are a common complication that leads to increased costs and mortality (Smith, Meixler, & Simberkoff, 1991). It is estimated that approximately 51% of hospital-acquired bloodstream infections occur in an intensive care unit (ICU), with the presence of a central venous catheter being the largest risk factor for the development of a bloodstream infection in the hospital (Wisplinghoff et al., 2004). Catheter-related bloodstream infections (CRBSIs) commonly occur when the catheter becomes contaminated by microbes on the skin during insertion. The use of maximal sterile barriers, including sterile gloves, long-sleeved sterile gown, mask, cap, and full-sized sterile drape, during insertion of the catheter has been shown to cost effectively reduce CRBSI rates compared to the use of less stringent precautions (Raad et al., 1994; Sheretz et al., 2000; Carrer et al., 2005; Lee, Jung, & Choi, 2008).

Clinical Recommendation Statements:

Maximal sterile barrier precautions: Use maximal sterile barrier precautions, including the use of a cap, mask, sterile gown, sterile gloves, and a sterile full body drape, for the insertion of CVCs, peripherally inserted central catheters (PICCS), or guidewire exchange (Centers for Disease Control and Prevention [CDC], 2011).

Hand hygiene: Perform hand hygiene procedures, either by washing hands with conventional soap and water or with alcohol-based hand rubs (ABHR).

Skin Preparation: Prepare clean skin with a greater than 0.5% chlorhexidine preparation with alcohol before central venous catheter and peripheral arterial catheter insertion and during dressing changes. If there is a contraindication to chlorhexidine, tincture of iodine, an iodophor, or 70% alcohol can be used as alternatives.

Sterile Ultrasound: The Food and Drug Administration recommends that policies and clinical practice standards be reviewed to ensure the use of sterile ultrasound gel. Once a container of sterile or non-sterile ultrasound gel is opened, it is no longer sterile and contamination during ongoing use is possible.

Evidence for Rationale

American Society of Anesthesiologists (ASA). Prevention of central venous catheter (CVC)-related bloodstream infections. Schaumburg (IL): American Society of Anesthesiologists (ASA); 2015 Oct 1. 2 p.

Carrer S, Bocchi A, Bortolotti M, Braga N, Gilli G, Candini M, Tartari S. Effect of different sterile barrier precautions and central venous catheter dressing on the skin colonization around the insertion site. Minerva Anestesiol. 2005 May;71(5):197-206. PubMed External Web Site Policy

Centers for Disease Control and Prevention (CDC). 2011 guidelines for the prevention of intravascular catheter-related infections. [internet]. Atlanta (GA): Centers for Disease Control and Prevention (CDC); 2011 Apr 1. 

Lee DH, Jung KY, Choi YH. Use of maximal sterile barrier precautions and/or antimicrobial-coated catheters to reduce the risk of central venous catheter-related bloodstream infection. Infect Control Hosp Epidemiol. 2008 Oct;29(10):947-50. PubMed External Web Site Policy

Raad II, Hohn DC, Gilbreath BJ, Suleiman N, Hill LA, Bruso PA, Marts K, Mansfield PF, Bodey GP. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol. 1994 Apr;15(4 Pt 1):231-8. PubMed External Web Site Policy

Sherertz RJ, Ely EW, Westbrook DM, Gledhill KS, Streed SA, Kiger B, Flynn L, Hayes S, Strong S, Cruz J, Bowton DL, Hulgan T, Haponik EF. Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med. 2000 Apr 18;132(8):641-8. PubMed External Web Site Policy

Smith RL, Meixler SM, Simberkoff MS. Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest. 1991 Jul;100(1):164-7. PubMed External Web Site Policy

Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004 Aug 1;39(3):309-17. PubMed External Web Site Policy

Primary Health Components

Perioperative care; central venous catheter (CVC)-related bloodstream infections; maximum sterile barrier technique; hand hygiene; skin preparation; sterile ultrasound techniques

Denominator Description

All patients, regardless of age, who undergo central venous catheter (CVC) insertion

Numerator Description

Patients for whom central venous catheter (CVC) was inserted with all elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Dataset
Medicare Limited Data Set Carrier SAF – 5% File; Anesthesia Quality Institute (AQI) National Anesthesia Clinical Outcomes Registry (NACOR)

Reliability
Reliability was calculated according to the methods outlined in a technical report prepared by J.L. Adams titled The Reliability of Provider Profiling: A Tutorial. In this context, reliability represents the ability of a measure to confidently distinguish the performance of one physician from another. As discussed in the report: "Conceptually, it is the ratio of signal to noise. The signal in this case is the proportion of variability in measured performance that can be explained by real differences in performance. There are 3 main drivers of reliability; sample size, differences between physicians, and measurement error."

According to this approach, reliability is estimated with a beta-binomial model. The beta-binomial model is appropriate for measuring the reliability of pass/fail measures such as those proposed.

Reliability was tested on providers, practices and facilities where at least 2 cases were reported.

Reliability for the process Prevention of Central Venous Catheter (CVC)-related Bloodstream Infections measure is consistently greater than 0.9, and thus can be considered to be very good. This reflects the inclusion of that measure in public reporting programs, the number of years that the measure has been reported and the number of cases available to test and analyze. In the three years of NACOR data that as analyzed, reliability has remained stable and consistent but performance rates, as increases in data capture grew, fell in 2014.

Validity
Face validity of the measure score as an indicator of quality was systematically assessed as follows. After the measure was fully specified, a group of experts was assembled to rate face validity. The experts included 19 physicians.

The developer provided the detailed measure specifications to the experts and asked them to rate their agreement with the following statement: The scores obtained from the measure as specified will provide an accurate reflection of quality and can be used to distinguish good from poor quality.

The rating scale had five levels (1 to 5) with the following narrative anchors: 1 = Disagree; 3 = Moderate Agreement; 5 = Agree

As additional data and information become available on this measure, the American Society of Anesthesiologists (ASA) intends to conduct further measure validity testing on this measure.

The results of the assessment of face validity indicate that an independent group of experts (different from those who advised on measure development) had high levels of agreement with the statement: "The scores obtained from the measure as specified will provide an accurate reflection of quality and can be used to distinguish good and poor quality."

Mean rating = (4.16 out of 5)

This measure was examined through a group of experts. Out of the 19 participants, 17 agreed that the scores from the measure as specified would provide an accurate reflection of quality and 2 disagreed.

Evidence for Extent of Measure Testing

National Quality Forum (NQF) measure submission form: prevention of central venous catheter (CVC)-related bloodstream infections. Washington (DC): National Quality Forum (NQF); 2015 Apr 10. 33 p.

State of Use

Current routine use

Current Use

Internal quality improvement

Pay-for-reporting

Professional certification

Public reporting

Measurement Setting

Ambulatory Procedure/Imaging Center

Hospital Inpatient

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

All ages

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Making Care Safer
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Staying Healthy

IOM Domain

Effectiveness

Safety

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients, regardless of age, who undergo central venous catheter (CVC) insertion

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Patients for whom central venous catheter (CVC) was inserted with all elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed

Note:

  • Maximal Sterile Barrier Technique: Includes all of the following elements: cap AND mask AND sterile gown AND sterile gloves AND sterile full body drape.
  • Sterile Ultrasound Techniques: Require sterile gel and sterile probe covers.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Registry data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Prevention of central venous catheter (CVC)-related bloodstream infections.

Measure Collection Name

Perioperative Care

Submitter

American Society of Anesthesiologists - Medical Specialty Society

Developer

American Society of Anesthesiologists - Medical Specialty Society

Physician Consortium for Performance Improvement® - Clinical Specialty Collaboration

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Work Group Members

Alexander A. Hannenberg, MD (Co-chair); Andrew J. Patterson, MD, PhD (Co-chair); William R. Andrews, MD, MS; Rebecca A. Aslakson, MD, PhD; Daniel R. Brown, MD, PhD; Neal H. Cohen, MD, MPH, MS; Peggy Duke, MD; Heidi L. Frankel, MD; Lorraine M. Jordan, BSN, MS, PhD; Jeremy M. Kahn, MD, MS; Jason N. Katz, MD, MHS; Gerald A. Maccioli, MD; Catherine L. Scholl, MD; Todd L. Slesinger, MD; Victoria M. Steelman, PhD, RN; Avery Tung, MD

Work Group Staff

Meredith Herzog, American Board of Medical Specialties; Maureen Amos, American Society of Anesthesiologists; Mark Antman, DDS, MBA, American Medical Association; Elvia Chavarria, MPH, American Medical Association; Jodie Dvorkin, MD, MPH, American Medical Association; Kendra Hanley, MS, American Medical Association; Jennifer Heffernan, MPH, American Medical Association; Toni Kaye, MPH, American Medical Association; Kimberly Smuk, RHIA, American Medical Association; Elvira L. Ryan, MBA, BSN, RN, The Joint Commission

Financial Disclosures/Other Potential Conflicts of Interest

Conflicts, if any, are disclosed in accordance with the Physician Consortium for Performance Improvement® conflict of interest policy.

Endorser

National Quality Forum

NQF Number

2726

Date of Endorsement

2015 Dec 10

Measure Initiative(s)

Physician Quality Reporting System

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Oct

Measure Maintenance

Annually

Date of Next Anticipated Revision

2016 Nov

Measure Status

This is the current release of the measure.

This measure updates a previous version: American Society of Anesthesiologists, Physician Consortium for Performance Improvement®. Anesthesiology and critical care physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2008 Oct. 21 p. [5 references]

Source(s)

American Society of Anesthesiologists (ASA). Prevention of central venous catheter (CVC)-related bloodstream infections. Schaumburg (IL): American Society of Anesthesiologists (ASA); 2015 Oct 1. 2 p.

Measure Availability

Source available from the American Society of Anesthesiologists (ASA) Web site External Web Site Policy.

For more information, contact ASA at 1061 American Lane Schaumburg, IL 60173-4973; Phone: 847-825-5586; Fax: 847-825-1692; E-mail: info@asahq.org; Web site: asahq.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on January 2, 2008. The information was verified by the measure developer on January 11, 2008.

This NQMC summary was retrofitted into the new template on June 13, 2011.

This NQMC summary was edited by ECRI Institute on April 27, 2012.

Stewardship for this measure was transferred from the PCPI to the ASA. ASA informed NQMC that this measure was updated. This NQMC summary was updated by ECRI Institute on March 23, 2016. The information was verified by the measure developer on April 26, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For more information, please contact the American Society of Anesthesiologists (ASA) for downloading, use and reproduction at (847) 825-5589 or (202) 289-2222.

The Measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications.

The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain.

Commercial uses of the Measures require a license agreement between the user and the American Medical Association (AMA), [on behalf of the Physician Consortium for Performance Improvement® (PCPI®)] or American Society of Anesthesiologists (ASA). Neither the AMA, ASA, PCPI, nor its members shall be responsible for any use of the Measures.

The AMA's, PCPI's and National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measures is acknowledged. ASA is solely responsible for the review and enhancement ("Maintenance") of the Measures as of May 23, 2014. ASA encourages use of the Measures by other health care professionals, where appropriate.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

© 2014 American Medical Association and American Society of Anesthesiologists. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, ASA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.

CPT® contained in the Measures specifications is copyright 2004-2013 American Medical Association. LOINC® copyright 2004-2013 Regenstrief Institute, Inc. SNOMED CLINICAL TERMS (SNOMED CT®) copyright 2004-2013 College of American Pathologists. All Rights Reserved.

NQMC Disclaimer

The National Quality Measures Clearinghouse™ (NQMC) does not develop, produce, approve, or endorse the measures represented on this site.

All measures summarized by NQMC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public and private organizations, other government agencies, health care organizations or plans, individuals, and similar entities.

Measures represented on the NQMC Web site are submitted by measure developers, and are screened solely to determine that they meet the NQMC Inclusion Criteria.

NQMC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or its reliability and/or validity of the quality measures and related materials represented on this site. Moreover, the views and opinions of developers or authors of measures represented on this site do not necessarily state or reflect those of NQMC, AHRQ, or its contractor, ECRI Institute, and inclusion or hosting of measures in NQMC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding measure content are directed to contact the measure developer.

About NQMC Measure Summaries

NQMC provides structured summaries containing information about measures and their development.

Measure Summary FAQs


Measure Summaries

New This Week

View more and sign up for our Newsletter

Get Adobe Reader