FAQs: Central Line Insertion Practices (CLIP)

Emergently placed CLs

Q1: Should central line insertions that occur emergently be included in CLIP data?

Yes. All central line insertions that occur in a location that is performing CLIP surveillance must be included in a facility’s CLIP data, regardless of whether it is emergently placed. Facilities may include emergent placement in the comments field on the CLIP reporting form or may develop a custom field to capture this information, if they wish. This may allow identification of necessary quality improvement efforts for these types of insertions.

CLIP form for non-successful placement

Q2: Does a CLIP form need to be completed for every insertion attempt made?

Every insertion attempt which requires a new site preparation should be entered as a CLIP event in locations reporting CLIP.

Documented contraindication to chlorhexidine gluconate (CHG)

Q3: Will the system record adherence to appropriate skin prep if povidone iodine was used due to a documented allergy to CHG?

Yes, but only if there is documentation of contraindication to CHG. Chlorhexidine gluconate (CHG) must be used for appropriate skin prep adherence prior to central line insertions for all patients ≥ 60 days old unless there is a documented contraindication.

CLIP Bundle

Q4: What is included in the “NHSN CLIP Bundle”?

In NHSN for CLIP insertions, adherence to the bundle requires a “Yes” to all of the following:

• Hand hygiene performed
• Appropriate skin prep
  • Chlorhexidine gluconate (CHG) for patients ≥60 days old unless there is a documented contraindication to CHG
  • Povidone iodine, alcohol, CHG, or other specified for children <60 days old
• Skin prep agent has completely dried before insertion
• All 5 maximal sterile barriers used
  • Sterile gloves
  • Sterile gown
  • Cap
  • Mask worn
  • Large sterile drape (a large sterile drape covers the patient’s entire body)

The only allowed contraindications to CHG are the following:

• Patient is less than 2 months of age – chlorhexidine is to be used with caution in patients less than 2 months of age
• Patient has a documented/known allergy/reaction to CHG based products that would preclude its use
• Facility restrictions or safety concerns for CHG use in premature infants precludes its use

Non-observed or missing practice

Q5: How should non-observed or missing practice information be recorded in CLIP surveillance?

For example, if the observer enters the room after the procedure has begun, how should hand washing be recorded since it was not observed?

Efforts should be made to keep such occurrences to a minimum. If the observer enters the insertion scene after the insertion has begun, the observer should ask the inserter whether each of the insertion elements was performed and record that answer.