title: Electronic health record solutions to reduce central line-associated bloodstream infections by enhancing documentation of central line insertion practices, line days, and daily line necessity.
abstract: BACKGROUND
  Central line-associated bloodstream infections (CLABSIs) continue to cause preventable morbidity and mortality, but methods for tracking and ensuring consistency of CLABSI-prevention activities remain underdeveloped.
  
  
  METHODS
  We created an integrated electronic health record solution to prompt sterile central venous catheter (CVC) insertion, CVC tracking, and timely line removal. The system embedded central line insertion practices (CLIP) elements in inserter procedure notes, captured line days and new lines, matching each with its CLIP form and feeding back compliance, and enforced daily documentation of line necessity in physician progress notes. We examined changes in CLIP compliance and form submission, number of new line insertions captured, and necessary documentation.
  
  
  RESULTS
  Standard reporting of CLIP compliance, which measures compliance per CLIP form received, artificially inflated CLIP compliance relative to compliance measured using CVC placements as the denominator; for example, 99% per CLIP form versus 55% per CVC placement. This system established a higher threshold for CLIP compliance using this denominator. Identification of CVCs increased 35%, resulting in a decrease in CLABSI rates. The system also facilitated full compliance with daily documentation of line necessity.
  
  
  CONCLUSIONS
  Integrated electronic health records systems can help realize the full benefit of CLABSI prevention strategies by promoting, tracking, and raising the standard for best practices behavior.
authors.affiliation: Epidemiology and Infection Prevention, University of California Irvine Health, Orange, CA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Quan
authors.affiliation: Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA. Electronic address: scousins@uci.edu.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Cousins
authors.affiliation: Health Affairs Information Services, University of California Irvine Health, Orange, CA.
authors.forename: Darlene D
authors.initials: DD
authors.lastname: Porter
authors.affiliation: Nursing Informatics, University of California Irvine Health, Orange, CA.
authors.forename: Margaret
authors.initials: M
authors.lastname: O'Brien
authors.affiliation: Health Affairs Information Services, University of California Irvine Health, Orange, CA.
authors.forename: Scott
authors.initials: S
authors.lastname: Rudkin
authors.affiliation: Health Affairs Information Services, University of California Irvine Health, Orange, CA.
authors.forename: Brian
authors.initials: B
authors.lastname: Lambertson
authors.affiliation: Health Affairs Information Services, University of California Irvine Health, Orange, CA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Hoang
authors.affiliation: University of California Irvine Hospitalist Program Informatics, Orange, CA.
authors.forename: Amish A
authors.initials: AA
authors.lastname: Dangodara
authors.affiliation: Epidemiology and Infection Prevention, University of California Irvine Health, Orange, CA; Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Huang
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000379:methods*; D057189:Checklist; D057286:Electronic Health Records; D006801:Humans; D017053:Infection Control / Q000379:methods*; D018805:Sepsis / Q000453:epidemiology* / Q000517:prevention & control*
keywords: Central venous catheter; Checklist