PROTECT YOUR HOSPITAL OR HEALTH CARE ORGANIZATION FROM A CLABSI
If a central line becomes infected as a result of a patient tampering with the line, but your institution has evidence that the patient tampered with the line through injection, the new infection is considered a true infection but not recorded as a CLABSI. One important strategy to demonstrate this tampering is the application of the tamper evident technology of the Neuma Central Line Protection Clamp.
We confirmed with the CDC that a Neuma Clamp removed by the patient, accompanied by further documentation of suspicion that the patient is self-injecting into their line, can be sufficient evidence for the infection to be downgraded to an LCBI (Laboratory Confirmed Bloodstream Infection); not a CLABSI.
This is an important clarification by the CDC because now, in addition to deterring and detecting line abuse by IVDU patients, the Neuma Clamp can be used as evidence along with documented suspicion of injecting, and therefore qualify for the CLABSI exclusion specific to injections.
From the CDC National Health Safety Network Publication, January 2019 https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf Pages 4-11
Patient Injection: A BSI* meeting LCBI* criteria that is accompanied by documentation of observed or suspected patient injection into the vascular access line … will be considered an LCBI but not a CLABSI for NHSN reporting purposes. This exclusion is very specific to “INJECTION”. Manipulating or tampering with the line (such as biting, picking at, sucking on, etc.) DOES NOT meet the intent of this exclusion. The documentation must state specifically that the patient was “observed injecting...” or “suspected of injecting…” the device. Insinuations or descriptive events that suggest such behavior DO NOT meet the intent of this exclusion.
*LCBI Laboratory Confirmed Bloodstream Infection
**BSI Blood Stream Infection
Correspondence with the CDC Regarding the Neuma Clamp
The CDC tracks HAI (Healthcare Associated Infections) through its National Health Safety Network (NHSN). The NHSN Patient Safety Component Manual is the authoritative source for the criteria that define HAI, including Central Line Associated Blood Stream Infections (CLABSI). The NHSN Manual requires the reporting of CLABSI if infections meet the definition of CLABSI. However, the manual allows for exceptions. For instance on page 4-11, the 2019 NHSN Manual states
"Patient Injection: A BSI* meeting LCBI* criteria that is accompanied by documentation of observed or suspected patient injection into the vascular access line, within the BSI** IWP, will be considered an LCBI but not a CLABSI for NHSN reporting purposes. This exclusion is very specific to “INJECTION”.
In order to clarify this statement, we contacted the CDC. Their response was:
"Thank you for your question as NHSN is always interested in new technologies that help prevent HAIs. Concerning your specific question, NHSN would not accept documentation of the removal of the tamper-evident clamp to meet the IV drug abuser CLABSI exclusion. While this may be a reason the clamp was removed, there is a possibility that there are other reasons the clamp is absent. However in discussion with the NHSN team, the removal of the clamp would indicate the facility suspects the patient is injecting into their central line. Documentation of suspicion of injection within the BSI IWP is acceptable documentation and is eligible for use to meet this CLABSI exclusion."
Conclusion
If the documentation of removal of the Clamp is accompanied by further documentation of suspicion that the patient is injecting into their line, this dual documentation of removal of the Clamp and suspicion of injecting is “eligible for use to meet this CLABSI exclusion”. If these two components can be legitimately documented, the LCBI "will be considered an LCBI but not a CLABSI for NHSN reporting purposes.”
If a central line becomes infected as a result of a patient tampering with the line, but your institution has evidence that the patient tampered with the line through injection, the new infection is considered a true infection but not recorded as a CLABSI. One important strategy to demonstrate this tampering is the application of the tamper evident technology of the Neuma Central Line Protection Clamp.
We confirmed with the CDC that a Neuma Clamp removed by the patient, accompanied by further documentation of suspicion that the patient is self-injecting into their line, can be sufficient evidence for the infection to be downgraded to an LCBI (Laboratory Confirmed Bloodstream Infection); not a CLABSI.
This is an important clarification by the CDC because now, in addition to deterring and detecting line abuse by IVDU patients, the Neuma Clamp can be used as evidence along with documented suspicion of injecting, and therefore qualify for the CLABSI exclusion specific to injections.
From the CDC National Health Safety Network Publication, January 2019 https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf Pages 4-11
Patient Injection: A BSI* meeting LCBI* criteria that is accompanied by documentation of observed or suspected patient injection into the vascular access line … will be considered an LCBI but not a CLABSI for NHSN reporting purposes. This exclusion is very specific to “INJECTION”. Manipulating or tampering with the line (such as biting, picking at, sucking on, etc.) DOES NOT meet the intent of this exclusion. The documentation must state specifically that the patient was “observed injecting...” or “suspected of injecting…” the device. Insinuations or descriptive events that suggest such behavior DO NOT meet the intent of this exclusion.
*LCBI Laboratory Confirmed Bloodstream Infection
**BSI Blood Stream Infection
Correspondence with the CDC Regarding the Neuma Clamp
The CDC tracks HAI (Healthcare Associated Infections) through its National Health Safety Network (NHSN). The NHSN Patient Safety Component Manual is the authoritative source for the criteria that define HAI, including Central Line Associated Blood Stream Infections (CLABSI). The NHSN Manual requires the reporting of CLABSI if infections meet the definition of CLABSI. However, the manual allows for exceptions. For instance on page 4-11, the 2019 NHSN Manual states
"Patient Injection: A BSI* meeting LCBI* criteria that is accompanied by documentation of observed or suspected patient injection into the vascular access line, within the BSI** IWP, will be considered an LCBI but not a CLABSI for NHSN reporting purposes. This exclusion is very specific to “INJECTION”.
In order to clarify this statement, we contacted the CDC. Their response was:
"Thank you for your question as NHSN is always interested in new technologies that help prevent HAIs. Concerning your specific question, NHSN would not accept documentation of the removal of the tamper-evident clamp to meet the IV drug abuser CLABSI exclusion. While this may be a reason the clamp was removed, there is a possibility that there are other reasons the clamp is absent. However in discussion with the NHSN team, the removal of the clamp would indicate the facility suspects the patient is injecting into their central line. Documentation of suspicion of injection within the BSI IWP is acceptable documentation and is eligible for use to meet this CLABSI exclusion."
Conclusion
If the documentation of removal of the Clamp is accompanied by further documentation of suspicion that the patient is injecting into their line, this dual documentation of removal of the Clamp and suspicion of injecting is “eligible for use to meet this CLABSI exclusion”. If these two components can be legitimately documented, the LCBI "will be considered an LCBI but not a CLABSI for NHSN reporting purposes.”
