Central venous catheter care and the healthcare–environment interface

Background Central line-associated bloodstream infections (CLABSI) are major indicators of healthcare quality and patient safety, particularly in resource-constrained intensive care units (ICUs). Aim This study aimed to evaluate a pre-post quality improvement (QI) initiative designed to optimize central venous catheter (CVC) insertion and maintenance, reducing CLABSI rates, and promoting more sustainable critical care practices in a university hospital ICU. Methodology A one-year pre–post QI study (October 2022–September 2023) was conducted in an emergency surgical ICU of a university hospital in Egypt hospital. The study was structured according to the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) framework and using sequential Plan-Do-Study-Act (PDSA) cycles. All eligible ICU patients needing CVCs were included. The intervention included: (1) standardizing CLABSI definitions and rate calculations, (2) introducing CVC insertion and maintenance checklists with daily audits, (3) targeted staff education and training, and (4) forming a multidisciplinary CLABSI working group for monitoring and feedback. Over 6 months, process improvements were implemented, followed by 3 months of impact measurement, including assessing CVC insertion/maintenance compliance, CLABSI rates, and device utilization ratio (DUR), with all data collected manually. Results A total of 1,370 patients and 2,277 CVC days were observed. The CLABSI rate declined from 7.56 ± 2.26 to 6.97 ± 1.31 per 1,000 CVC days (−13.4%), and DUR decreased significantly from 2.21 ± 0.34 to 0.98 ± 0.19 ( p = 0.02). Maintenance bundle compliance improved from 39.5 to 59.7% ( p = 0.01), and insertion compliance increased from 62.5 to 72% ( p = 0.6). Hand hygiene adherence demonstrated a strong negative correlation with CLABSI rates ( r = −0.95, p = 0.02). Conclusion This single-center study had a small sample size and short post-intervention follow-up, which may limit generalizability. Nonetheless, the initiative demonstrates that structured, low-cost QI interventions can improve compliance, reduce device use, and may support safer, more environmentally sustainable ICU care. Continuous monitoring and multicenter validation that integrate infection control with environmental stewardship are essential to sustain improvements and minimize the environmental footprint of critical care. Digital surveillance and ongoing training can improve real-time monitoring and scalability in healthcare systems

Central venous catheter · Continuous monitoring · Health care · Intensive care unit · Psychological intervention · Quality management · Acute Kidney Injury Research · Central Venous Catheters and Hemodialysis · Sepsis Diagnosis and Treatment

• Systematic review of the Hawthorne effect

  Open Access•Jim Mccambridge, John Witton et al.•Journal of Clinical Epidemiology•2014

  Add to list

• Central line-associated bloodstream infection rates in intensive care units of China’s hospitals

  Open Access•Minghong Cai, Xiaoyan Jiang et al.•Frontiers in Public Health•2025

  Add to list