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

Central line-associated bloodstream infections (CLABSIs) remain a major source of preventable harm and cost. Although daily chlorhexidine gluconate (CHG) bathing is recommended for patients with central venous catheters (CVCs), adherence is often inconsistent in non-intensive care unit (ICU) settings where device visibility and maintenance workflows may be less standardized.

To improve the consistency of CHG bath ordering and documentation among non-ICU adult inpatients with CVCs in a community hospital.

We conducted a single-center quality improvement project using system redesign principles. Interventions included enhanced electronic medical record visibility of CVCs, standardized CHG bath orders within CVC maintenance workflows, and multidisciplinary education and feedback. Process measures included CHG bath order placement compliance and CHG bath completion compliance. Run charts evaluated trends over time.

At baseline, CHG bathing orders were lower among patients who developed CLABSI compared with those who did not (42% vs. 60%). The baseline rate of documented CHG baths was 0.42 baths per central line day among patients without CLABSI compared with 0.22 baths per central line day among patients with CLABSI. After implementation, CHG bath order compliance improved to 66-80% and bath completion compliance improved to 69-78%. After stabilization, documented CHG bathing increased to 0.84 baths per central line day.

System-level workflow redesign improved reliability of CHG bath ordering and documentation for patients with CVCs in non-ICU settings.

System-level approaches that prioritize leadership engagement and standardization may help improve central line maintenance practices in non-ICU settings.