Enhancing Reliability in Non-ICU Central Line Maintenance Through System Redesign: A Quality Improvement Initiative

Area of Science:

• Healthcare quality improvement
• Infection prevention and control
• Patient safety

Background:

• Central line-associated bloodstream infections (CLABSIs) pose significant risks and costs.
• Daily chlorhexidine gluconate (CHG) bathing is recommended for central venous catheter (CVC) patients but adherence is inconsistent in non-intensive care units (non-ICUs).
• Non-ICU settings often have less standardized device visibility and maintenance workflows, impacting CHG bathing consistency.

Purpose of the Study:

• To enhance the consistency of CHG bath ordering and documentation for adult inpatients with CVCs in non-ICU settings.
• To address the challenge of inconsistent CHG bathing practices outside of the ICU.
• To improve patient safety by optimizing CVC care protocols.

Main Methods:

• A single-center quality improvement project utilizing system redesign principles was implemented.
• Interventions included improving electronic medical record visibility of CVCs and standardizing CHG bath orders within CVC maintenance workflows.
• Multidisciplinary education, feedback, and process measures (order placement and bath completion compliance) were employed, with run charts analyzing trends.

Main Results:

• Baseline CHG bathing orders were lower in patients who developed CLABSI (42%) versus those who did not (60%).
• Documented CHG baths increased from 0.22 to 0.84 baths per central line day after implementation.
• CHG bath order compliance improved to 66-80%, and bath completion compliance rose to 69-78%.

Conclusions:

• System-level workflow redesign successfully improved the reliability of CHG bath ordering and documentation for CVC patients in non-ICU settings.
• Standardization and leadership engagement are key to improving central line maintenance practices in non-ICU environments.
• These findings highlight the effectiveness of systematic approaches in enhancing patient safety and reducing healthcare-associated infections.