P2.N278: Improving Compliance with Aseptic Handling of Central Venous Catheters: An Infection Prevention and Control Quality Improvement Project

Purpose/Objectives: Central line-associated bloodstream infections (CLABSIs) pose serious risks and increase healthcare expenses, particularly affecting cancer patients with long-term central line placements. Aseptic handling of central venous catheters (AHCVCs) effectively lowers CLABSI rates. This quality improvement (QI) project aims to reduce central line contamination and bloodstream infections by improving AHCVC compliance (handwashing, glove use, hub scrub) to 75% among pediatric oncology ward (POW) patients with central vein catheters at the University Pediatric Hospital within 12 months.

Design/Methods: Compliance with AHCVCs was observed by covert observations from residents rotating in the POW. Inclusion criteria included nursing staff working at the POW who handle CVCs on weekdays from 7am-5pm. The QI team included the authors, residents in POW, nursing staff in POW, infection and prevention and control (IPC) team, and medical director. Strategies in PDSA cycles aimed at reaching the goal included promoting handwashing through placement of posters bedside, awareness and support from the medical director and IPC team, educational brochures on CLABSIs and AHCVCs for parents, sharing epidemiology data, and reviewing the AHCVCs protocol with medical and nursing staff. Outcome measures were the AHCVCs compliance percentage, evaluated and further strategies developed at each PDSA cycle. All observations were plotted on run charts.

Results: Baseline data showed deficiencies in handwashing and glove use compliance at bedside, ranging from 17 to 25%. The scrub the hub technique was initially 75-83% compliant. With interventions, scrub the hub technique and glove use improved to 100% after 4 PDSA cycles, but handwashing compliance did not sustainably reach the goal of 75%. Challenges included sporadic CVC handling during day shifts, affecting observation consistency.

Conclusion/Discussion: While hub scrub and glove use compliance improved significantly, handwashing did not reach the goal. Further PDSA cycles will be continued to evaluate sustainability of compliance and to implement strategies to improve hand washing compliance. Implementation of the brochure was well-received, increasing awareness among parents and nursing staff. Involvement of residents, IPC team, nursing staff, and parents increased awareness of proper AHCVCs. The medical director's support provided systemic and administrative backing. Further interventions are planned to enhance data collection and observation consistency.