Quality Improvement of Documentation of the Use of Chlorhexidine in Patients with Central Venous Catheters

The objectives of this poster presentation are to (1) determine the causes for the lack of documentation of chlorhexidine (Hibiclens) in patients with central lines, then (2) differentiate the reasons for these causes.  A central venous catheter is an intravenous port placed in a large vein of a patient. Central venous catheters are direct access devices that allow healthcare providers to deliver long-term treatments to their patients; furthermore, these devices are used for administration of fluids, medications, parental nutrition, and the drawing of labs. According to the Joint Commission, “CVCs are the most frequent cause of health care–associated bloodstream infections.” After interviewing the Clinical Decision Unit manager at a central Kentucky Hospital, it was brought to our attention that the documentation of using Hibiclens during central venous line care is an issue on the unit. To investigate this issue within the unit a written survey will be performed by the hospital infectious control team, unit administrative staff, and twenty floor nurses to determine the reasons why chlorhexidine (Hibiclens) is not being documented. From these results, a review of the documentation system and of the central line care kit will be performed to differentiate the causes. After all data is collected, an analysis will be performed to code the data and draw conclusions as to why there is minimal documentation. Then, interview of a sample of the nurses will be performed in order to discuss the responsibility involved with the documentation of the use of Hibiclens. The hypothetical outcomes to be found include no use of chlorhexidine (Hibiclens) related to time deficit or lack of education; therefore, no documentation. This is also hypothosized to be possibly related to unclear documentation responsibility, lack of time, and inadequate education regarding the documentation system. Once data is confirmed, recommendations to the nurse administrators of the unit will be provided, based on the guidelines discovered from The Joint Commission and other sources.