Authors (including presenting author) :
Lee SH(1)(2), Ho LF(1)(2), Au CP(1)(2), Leung SY(1)(2), Lee TF(1)(2), Hung MS(1)(2), Lo KP(1)(2)
Affiliation :
(1)Medicine and Geriatrics, Princess Margaret Hospital, (2)Nephrology Unit
Keyword 2: :
Standardized Video training
Keyword 3: :
Systematic auditing
Introduction :
This quality improvement project was initiated in response to internal surveillance data and direct practice observations within the Renal Ward, which identified significant variability in aseptic technique during central venous catheter (CVC) access procedures. Specifically, inconsistent "scrub-the-hub" practices and breaks in sterile connection/disconnection were noted as high-risk, modifiable factors contributing to central line-associated bloodstream infections (CLABSI). The project targets these frequent, nurse-led moments of care to standardize practice and reduce infection risk.
Objectives :
To standardize aseptic catheter access procedures and enhance nursing compliance through mandatory video-based training and systematic auditing, thereby reducing the incidence and rate of CLABSI in the Renal Ward.
Methodology :
1. Develop & deploy standardized procedure videos focused on "scrub-the-hub" and aseptic connection to ensure consistent practice. 2. Implement a monthly audit cycle with direct observation and immediate feedback to correct procedural lapses. 3. Apply the PDSA framework: Plan the intervention, Do the training and audits, Study the compliance and outcome data monthly, and Act to refine the process for continuous improvement.
Result & Outcome :
Since the full implementation of a targeted, standardized catheter access program in August 2025, the Renal Ward has observed a complete elimination of CLABSI in the fourth quarter (Q4) of 2025, with 0 reported cases and a corresponding CLABSI rate of 0‰. This marks a substantial improvement from the first half of the year, during which 10 CLABSI cases (including 4 MRSA-related) were recorded in Q1 and Q2. The quarterly CLABSI rate decreased from 0.71‰ (Q2) to 0.28‰ (Q3), and subsequently to 0‰ in Q4. The sustained absence of new CLABSI following the intervention strongly demonstrates the effectiveness of standardized video training and compliance auditing in eliminating central line-associated bloodstream infections.
