JHQ 4841: Enhancing Reliability in Non-ICU Central Line Maintenance Through System Redesign: A Quality Improvement Initiative-Enhancing Reliability in Non-ICU Central Line Maintenance Through System Redesign: A Quality Improvement Initiative

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

Pdf Summary

This single-center quality improvement initiative aimed to improve daily chlorhexidine gluconate (CHG) bathing order and documentation for adult non-ICU inpatients with central venous catheters (CVCs), where maintenance practices were inconsistent.<br /><br />The team used workflow mapping and root cause analysis to identify barriers, including poor visibility of CVCs in the electronic medical record (EMR), variable ordering practices, documentation gaps, and intermittent supply availability. Over 12 weeks, three interventions were introduced through Plan-Do-Study-Act cycles: an EMR indicator highlighting patients with CVCs, standardized CHG orders within CVC maintenance workflows, and multidisciplinary education with performance feedback.<br /><br />After implementation, weekly CHG order compliance rose to 66–80%, while bath completion compliance reached 69–78%; both showed sustained improvement above baseline on run charts. Following stabilization, documented bathing increased from 0.42 to 0.84 baths per central line day. At baseline, patients who developed CLABSI had lower CHG order rates and fewer documented baths than patients who did not. The hospital’s standardized infection ratio also declined, but the study cannot establish that the intervention caused this change.<br /><br />The findings suggest that workflow redesign and improved device visibility can strengthen central line maintenance without additional staffing. Limitations include the single-center design, no control group, few CLABSI events, and reliance on documentation as a measure of completed bathing. The authors emphasize leadership, standardization, and ongoing monitoring to sustain improvements in non-ICU settings.

Keywords

chlorhexidine gluconate bathing

central venous catheters

non-ICU inpatients

quality improvement

EMR indicator

workflow redesign

CLABSI prevention

documentation compliance

Plan-Do-Study-Act cycles

infection control