Central Venous Catheter Care and the Healthcare–Environment Interface: Outcomes of a Quality Improvement Initiative in a Resource-Constrained ICU

Rehab Hosny El-sokkary^1*Essamedin M. Negm²Fayrouz Abd ElNaser³Al Zahraa Mohammed Soliman²Amira Hamed Mohamed Afifi²Samar SA Morsi²Alaa O. Abdel-Kareem²Afaf M. Eladl²Mona H Ibrahim²Maha Abdeldayem²Mai Mohamed Malek²

• ¹Faculty of Medicine, Zagazig University, Zagazig, Egypt
• ²Zagazig University Faculty of Medicine, Zagazig, Egypt
• ³Hospitals, Zagazig University, Zagazig, Egypt

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 six months, process improvements were implemented, followed by three 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.