Measure Description
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
Instructions
This measure is to be submitted each time a CVC insertion is performed during the performance period. There is no diagnosis associated with this measure. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who perform CVC insertion will submit this measure.
Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator
All patients, regardless of age, who undergo CVC insertion
Denominator Criteria (Eligible Cases):
Patient procedure during the performance period (CPT): 36555, 36556, 36557, 36558, 36560, 36561, 36563, 36565, 36566, 36568, 36569, 36570, 36571, 36572, 36573, 36578, 36580, 36581, 36582, 36583, 36584, 36585, 93503
Numerator
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
Definitions:
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.
Hand Hygiene—Washing hands with conventional soap and water or with alcohol-based hand rubs (ABHR)
Numerator Options:
Performance Met: All elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed (6030F)
OR
Denominator Exception: Documentation of medical reason(s) for not following all elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques during CVC insertion (including increased risk of harm to patient if adherence to aseptic technique would cause delay in CVC insertion) (6030F with 1P)
OR
Performance Not Met: All elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques not followed, reason not otherwise specified (6030F with 8P)
Rationale
Catheter-related bloodstream infection is a costly complication of central venous catheter 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. 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. 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.
Clinical Recommendation Statements
2011 Guidelines for Prevention of Intravascular Catheter-Related Infections. CDC Healthcare Infection Control Practices Advisory Committee (HICPAC).
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, PICCS, or guidewire exchange (CDC) (Category IB)
Hand hygiene: Perform hand hygiene procedures, either by washing hands with conventional soap and water or with alcohol-based hand rubs (ABHR) (Category IB)
Skin Preparation: Prepare clean skin with a >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 (Category IB)
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.
2012 American Society of Anesthesiologists Practice Guidelines for Central Venous Access
In preparation for the placement of central venous catheters, use aseptic techniques (e.g., hand washing) and maximal barrier precautions (e.g., sterile gowns, sterile gloves, caps, masks covering both mouth and nose, and fullbody drapes).
2014 American Institute for Ultrasound in Medicine Practice Parameter for the Performance of Selected Ultrasound-Guided Procedures
The use of sterile drapes, sterile probe covers, and sterile ultrasound gel may provide the best method to reduce the risk of contamination and infection.