AQI 73: Prevention of Arterial Line-Related Bloodstream Infections

MEASURE DESCRIPTION:

Percentage of patients, regardless of age, who undergo placement of a peripheral intra-arterial catheter for whom the arterial line was inserted with all indicated elements of sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed

The measure will consist of two performance rates:

**AQI73a: Percentage of patients, regardless of age, who undergo placement of a peripheral intra-arterial line in the brachial, radial, posterior tibial, or dorsalis pedis artery for whom the arterial line was inserted with all indicated elements of sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed

**AQI73b: Percentage of patients, regardless of age, who undergo placement of a peripheral intra-arterial line in the femoral or axillary artery for whom the arterial line was inserted with all indicated elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound technique is followed

NOTE: The overall measure score will be calculated as an average of the total cases of part A and part B.

NQS DOMAIN/MEANINGFUL MEASURES AREA:
Patient Safety/Healthcare Associated Infections

MEASURE TYPE:
Composite

HIGH PRIORITY STATUS:
Yes

INVERSE MEASURE:
No

RISK ADJUSTED:
No

INSTRUCTIONS:

This measure consists of two performance rates: AQI73a and AQI73b. Each measure should be reported, as appropriate, for each time a patient undergoes a procedure undergo placement of a peripheral intra-arterial catheter for whom the arterial line was inserted. This measure has two sub-metrics which are used to calculate the total composite score. The overall measure score will be calculated as an average of the total cases of part A and part B. It is anticipated that qualified anesthesia providers and eligible clinicians who provide denominator-eligible services will submit this measure.

Measure Reporting via the Qualified Clinical Data Registry

Patient demographics and CPT codes are used to identify patients who are included in the measure denominator. G-codes and Registry Codes are used to capture the numerator.

RATIONALE:

Arterial lines have been shown to be a significantly under-recognized source of catheter-related bloodstream infections. Though arterial catheter infection rates are similar to those associated with central venous catheters, the use of sterile barrier techniques for arterial line insertion is limited. Appropriate use of sterile techniques is essential to prevent costly and dangerous infections. Furthermore, the insertion of an arterial line in the femoral or axillary artery increases the likelihood of a blood stream infection in adults.

**AQI 73a - Brachial, Radial, Posterior Tibial, or Dorsalis Pedis Arterial Lines**

MEASURE DESCRIPTION-AQI73a:

Percentage of patients, regardless of age, who undergo an arterial line insertion in the brachial, radial, posterior tibial, or dorsalis pedis artery for whom the arterial line was inserted with all indicated elements of sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed

DENOMINATOR-AQI73a:

All patients, regardless of age, who undergo placement of an intra-arterial catheter in the brachial, radial, posterior tibial or dorsalis pedis artery

Denominator Criteria (Eligible Cases) AQI73a:

All patients, regardless of age

AND

Patient encounter during the reporting period (CPT):

36620
AND

Intra-arterial catheter placed in brachial, radial, posterior tibial, or dorsalis pedis artery: 11A71
Denominator Exclusions-AQI73a:

None

NUMERATOR-AQI73a:

Patients for whom intra-arterial catheter was inserted with all indicated elements of sterile barrier technique, hand hygiene, skin preparation (including >0.5% chlorhexidine with alcohol, unless there is a contraindication to chlorhexidine), and, if ultrasound is used, sterile ultrasound techniques followed

Numerator Definitions:

Sterile Barrier Technique: Includes all of the following elements: Cap AND mask AND sterile gloves AND sterile draping.

Sterile Ultrasound Techniques: Require sterile gel and sterile probe covers

Numerator Options-AQI73a:

Performance Met: All indicated elements of sterile barrier technique, hand hygiene, skin preparation, and, if ultrasound is used, sterile ultrasound techniques followed. (11A74)

OR

Performance Not Met: All indicated elements of sterile barrier technique, hand hygiene, skin preparation, and if ultrasound is used, sterile ultrasound techniques not followed, reason not otherwise specified. (11A76)

OR

Denominator Exception: Documentation of medical reason(s) for not following all indicated elements of sterile barrier technique, hand hygiene, skin preparation, and, if ultrasound is used, sterile ultrasound techniques during intra-arterial catheter insertion (e.g., An emergency surgical, therapeutic, or diagnostic procedure or an unanticipated worsening of the patient’s clinical condition so that adherence would cause delay in arterial line insertion resulting in increased risk of harm to patient) (11A75)

**AQI 73b - Femoral and Axillary Arterial Lines**

MEASURE DESCRIPTION-AQI73b:

Percentage of patients, regardless of age, who undergo an arterial line insertion in the femoral or axillary artery for whom the arterial line was inserted with all indicated elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed.

DENOMINATOR-AQI73b:

All patients, regardless of age, who undergo placement of an intra-arterial catheter in the femoral or axillary artery

Denominator Criteria (Eligible Cases)-AQI73b:

All patients, regardless of age

AND

Patient encounter during the reporting period (CPT):

36620

AND

Intra-arterial catheter placed in femoral or axillary artery: 11A72
Denominator Exclusions-AQI73b:

None

NUMERATOR-AQI73b:

Patients for whom intra-arterial catheter was inserted with all elements of maximal sterile barrier technique, hand hygiene, skin preparation (including >0.5% chlorhexidine with alcohol, unless there is a contraindication to chlorhexidine), and, if ultrasound is used, sterile ultrasound techniques followed

Numerator Definitions:

Maximal Sterile Barrier Technique – includes all of the following elements: Cap AND mask AND sterile gloves AND sterile gown AND sterile full body draping

Sterile Ultrasound Techniques – Require sterile gel and sterile probe covers

Numerator Options-AQI73b:

Performance Met: All elements of maximal sterile barrier technique, hand hygiene, skin preparation, and, if ultrasound is used, sterile ultrasound techniques followed. (11A77)

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. (11A79)

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 intra-arterial catheter insertion (e.g., An emergency surgical, therapeutic, or diagnostic procedure or an unanticipated worsening of the patient’s clinical condition so that adherence would cause delay in arterial line insertion resulting in increased risk of harm to patient). (11A78)

RELEVANT FIELDS:

Date of service
Date of birth
Type of Arterial line placed
Sterile technique used

REPORTING CODES: