Improving placement of central venous catheters in 22 hospitals in China: a best practice implementation project

INTRODUCTION: Correct central venous catheter (CVC) placement is important, as inappropriate practices can lead to central line-associated bloodstream infections (CLABSIs), which increase the risk of death as well as imposing a heavy financial burden. OBJECTIVES: This multi-site project was conducted across 22 hospitals in China, and aimed to improve compliance with evidence-based bundles for the placement of CVCs among doctors, anesthetists, and operating room specialized nurses to reduce the rate of CLABSIs. METHODS: This project was guided by the JBI Model of Evidence-based Healthcare and the seven-phase JBI Evidence Implementation Framework. The evidence-based procedure for CVC placement was developed using the JBI FAME framework. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tools were also used to support implementation planning, data collection, data analysis. RESULTS: Following project implementation, clinical practices improved significantly. Adherence to maximum barrier precautions and CVC placement using ultrasound guidance increased by approximately 35%. Overall bundle compliance rose from 77.37% to 93.73%. These improvements were associated with an 84.3% reduction in CLABSI incidence, which decreased from 1.53 to 0.24 per 1,000 central-line days. CONCLUSIONS: The project not only improved compliance with evidence-based bundles in the placement of CVCs in 22 hospitals, but also resulted in an evidence-based procedure and audit checklist, which can be applied at other sites. The project objectives were largely met, and the implementation of best clinical practices will be maintained. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A552.