Empowering Caregivers, Protecting Patients: An Ambulatory Central Line Quality Improvement Initiative for Education and Follow-up

Introduction: Preventing ambulatory central line-associated bloodstream infections (A-CLABSIs) is challenging due to inconsistent education, follow-up, and home care practices. Pediatric intestinal failure (IF) patients are particularly vulnerable. This institution aimed to decrease its IF A-CLABSI rate by 25% within 2 years through a standardized, step-by-step central line care education program. Methods: Using the Toyota problem-solving method, the team reviewed data and performed a root cause analysis of the prioritized problem, implementing a 2-phase education program. Phase 1 delivered in-hospital education using videos, handouts, and hands-on teaching with skill demonstration. The existing pediatric central line skills class was expanded and offered to partnering home health agencies. Phase 2 included postdischarge follow-up via phone calls or clinic visits to address questions and identify needs. Family feedback was collected through surveys. One hundred percent of families surveyed at 7 days postdischarge reported confidence in providing central line care at home and found follow-up phone calls very helpful. Among 44 home health staff trained, the mean percent improvement in pre- to posttest scores was 47%. Families and home health personnel especially valued the hands-on learning component. Conclusions: The standardized education program substantially reduced the rate of IF A-CLABSIs and improved confidence and satisfaction among families and home health nurses. It also enhanced collaboration among families, home health agencies, and the health system, fostering trust and continuity of care.