Tools for Reducing Central Line-Associated Blood Stream Infections

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Tools for Reducing Central Line-Associated Blood Stream Infections

Central Line Maintenance Audit Form

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Audit Date: ____/____/20____ Addressograph Here

1. Was the need for a central line for this patient discussed on patient rounds?

[ ] Yes [ ] Yes, as part of Daily Goals [ ] No

2. Was proper hand hygiene used by all personnel involved in line care for this patient (i.e., hand washing with soap and water or with alcohol-based hand sanitizer)?

[ ] Yes [ ] No, not during:_ _Dressing change_ _Accessing the line_ _Port/clave change __Other

3. If the line was percutaneously placed, was this line placed in a recommended site?

[ ] Yes (IJ, SC) [ ] No (femoral)

4. Was the dressing changed during this shift?

[ ] Yes, changed because:
     [ ] Dressing soiled, damp or non-occlusive
     [ ] Due to be changed (7 days for transparent OR 1 day for gauze)
     [  ] Changed by specific team (e.g., PICC, TNA)
     [  ] Dressing was overdue to be changed?
     ____ days for transparent
     ____ days for gauze

[ ] No, not changed because:
     [  ] It was intact and not due
     [  ] It was due but could not be completed.
     Explain:

5. Was Chloraprep© or 2% chlorhexidine in 70% Isopropyl alcohol used for skin antisepsis?

[ ] Yes:
     Was it used appropriately?
     [  ] Scrub vigorously back and forth for 30 seconds
     [ ] Groin sites 2 minutes
     [ ] Air dry up to 2 minutes
     [ ] No – Explain:

[ ] No, Povidone iodine used
Secondary to allergy?
[ ] Yes [ ] No – Explain:

Did scrub comply with recommendations?

Clean with soap and water or alcohol, air dry
Povidone iodine air dry 2 minutes
[ ] Yes [ ] No – Explain:

6. Were central line tubing and all additions (secondary tubing, etc.) changed during this shift?

[ ] Yes, completed because:
     [  ] Tubing due to be changed
     [  ] 72 hours since last change
     [ ] 24 hours for intralipids
     [ ] Medication tubing expired

[ ] No, not completed because
[ ] Not due to be changed
[ ] Due but could not be completed – Explain:

7. Was there blood return from each lumen? [ ] Yes [ ] No [ ] Unable to assess
(infusion can't be stopped)

Please specify lumen:

Use of Advanced Technology

8. Was a chlorhexidine impregnated BioPatch used? [ ] Yes [ ] No

9. Was a chlorhexidine impregnated occlusive dressing used? [ ] Yes [ ] No

10. Was an antibiotic coated catheter used at insertion? [ ] Yes [ ] No

11. What will you change to improve line maintenance practices?

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