CLABSI Insertion K-Card

HAC SPS Bundle Elements

Which department are you completing this survey for?

Name of the employee observed:

Patient MRN?

Did the insertor perform hand hygiene?

  • Perform hand hygiene procedures, either by washing hands with conventional soap and water or with alcohol-based hand rubs (ABHR). 
  •  Hand hygiene should be performed before and after palpating catheter insertion sites as well as before and after inserting, replacing, accessing, repairing, or dressing an intravascular catheter.
  • Palpation of the insertion site should not be performed after the application of antiseptic, unless aseptic technique is maintained [CDC Reference] 
Was the patients skin prepped with CHG/antiseptic prior to insertion?

  • Prepare clean skin with an antiseptic (70% alcohol, tincture of iodine, an iodophor or chlorhexidine gluconate) before peripheral venous catheter insertion [CDC Reference].
  •  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 [CDC Reference].
Was iodine used during the procedure?

Do not use topical antibiotic ointment or creams on insertion sites, except for dialysis catheters, because of their potential to promote fungal infections and antimicrobial resistance [CDC Reference] 
Was a pre-packaged insertion tray/kit utilized?

Catheter cart that contains all the necessary supplies (CDC Reference].
Was an Insertion checklist with staff empowerment to stop non-emergent procedure utilized?

  • Include a checklist to ensure adherence to proper practices [CDC Reference] .
  •  Stoppage of procedures in non-emergent situations, if evidence based practices were not being followed [CDC Reference].
Was sterility maintained during the procedure?

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. Use a sterile sleeve to protect pulmonary artery catheters during insertion [CDC Reference]. 
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