Implementing a 4% EDTA Central Catheter Locking Solution as a Quality Improvement Project in a Large Canadian...

Area of Science:

• Infection Control
• Vascular Access
• Patient Safety

Background:

• Central vascular access devices (CVADs) are crucial for oncology and critical care patients but increase risks of central line-associated bloodstream infections (CLABSIs) and thrombotic occlusions.
• CLABSIs saw a 63% rise during the COVID-19 pandemic, necessitating novel interventions.
• Four percent ethylenediaminetetraacetic acid (4% EDTA) is an antimicrobial agent known to reduce CLABSIs, occlusions, and biofilm formation.

Purpose of the Study:

• To evaluate the effectiveness of 4% EDTA as a catheter locking solution in reducing CLABSIs and central catheter occlusions.
• To assess the impact of 4% EDTA on patient safety in adult cancer and critical care units.

Main Methods:

• A retrospective pre-post quality improvement project was conducted across all adult cancer and critical care units at a regional cancer center.
• The study compared CLABSI and occlusion rates before and after the implementation of 4% EDTA as a locking solution.

Main Results:

• A statistically significant 59% decrease in CLABSIs per 1000 catheter days was observed after implementing 4% EDTA (36 cases in 16 months pre- vs. 6 cases in 6 months post-implementation).
• No significant difference was found in the rate of catheter occlusions (alteplase use) between the pre- and post-implementation periods.
• Patient outlook was largely positive or neutral (88%), with nurses expressing a preference for prefilled syringes of 4% EDTA.

Conclusions:

• The implementation of 4% EDTA as a catheter locking solution led to a significant reduction in CLABSIs in oncology and critical care settings.
• While 4% EDTA did not significantly affect catheter occlusion rates, its impact on CLABSI reduction warrants further investigation.
• Further randomized controlled trials are recommended to establish a definitive causal relationship and explore optimal use, considering potential influences like the pandemic and nursing shortages.