QAPI 126 - Whose Line Is It Anyway? Implementing a Line Stewardship Program to Decrease Unnecessary Devices

Background: Central line associated blood stream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs) are conditions acquired in the acute care facility that are preventable. Invasive devices are frequently left in place without a clear clinical indication, increasing the risk for infection. A line stewardship program was developed to decrease the number of unnecessary central venous catheters (CVCs), decrease the number of unnecessary urinary catheters (UCs), and increase provider acceptance rates of removal recommendations.

Methods: The program was implemented from March to November 2022 in seven facilities within a large hospital system. An interdisciplinary team consisting of infection preventionists and nurse leaders performed chart reviews of patients with CVCs and UCs to determine device necessity. If no clear clinical indications were identified, the primary nurse and physician were contacted, and removal was recommended. Run charts were used to identify trends throughout the implementation period.

Results: 3,492 patients were reviewed including 1,867 patients with CVCs and 1,625 with UCs. During this time, 370 UCs and 252 CVCs were removed per the team's recommendation. The median removal rate after the intervention was accepted was 85%. Initially we saw a decrease in provider acceptance rate of device removal as the program expanded and new facilities were added to the pilot; as the program became more established, we saw a rise in the provider acceptance rate. We also saw a decline in the percentage of devices recommended for removal from our baseline. This was anticipated as we hoped our program would have a larger impact on staff's attentiveness to line necessity prior to our team’s intervention.

Conclusions: The implementation of a line stewardship program helped to reduce the number of unnecessary CVCs and UCs despite variable provider acceptance of removal recommendations. It increased awareness of device duration and encouraged interdisciplinary communication regarding the plan of care.