CLABSI Is Rising and the Committee Wants "the Education Redone"

The 96% completion rate is the strongest argument in the room - against more of the same education. The staff already received the content; the outcome worsened. That pattern points to a gap between knowing and doing, which is a system and process problem.

Read the audit numbers as a diagnostic:

• 58% scrub-the-hub with staff reporting missing CHG = a supply-chain and point-of-use availability defect. No amount of classroom time fixes an empty cart.
• 71% necessity review with "that's the intensivists' job" = role ambiguity and a legitimate scope question about who owns the decision. That requires a medical director and a policy decision, not a module.

So the correct response to the committee is: "Education is one component; the primary drivers are supply availability and unclear ownership. Here is a 30-day plan that tests both." Use an EBP process - frame the question, appraise the evidence that bundle reliability (not bundle knowledge) prevents CLABSI, then run small PDSA cycles.

What would change my answer: if audits showed nurses could not state the bundle elements, knowledge would lead. They can; they are not reliably enabled to act.

Run parallel PDSA cycles on the two confirmed barriers, with education as a small supporting element.

• Supply cycle: stock CHG in every room and on the line cart with a par level and a daily check assigned by name; measure stock-out days. Escalate materials management with the stock-out count, not with complaints.
• Ownership cycle: with the medical director, define who performs necessity review, add it to the multidisciplinary rounding checklist, and have the physician champion state it on rounds. Test with a small checklist for two weeks.
• Audit-with-feedback cycle: brief, unit-level, non-punitive audits of scrub-the-hub with immediate coaching at the bedside. Feedback at the individual and unit level outperforms annual modules.
• Education: 10-minute just-in-time at the bedside and a huddle reminder - minimal dose, placed where the work happens.

Measures (family, not single):

• Process: % CHG availability, % necessity review documented on rounds, % scrub-the-hub observed.
• Outcome: CLABSI per 1,000 catheter-days, device days.
• Balancing: staff-reported time burden. Display as run charts, not before/after bars, so you can see whether change is real.

Report at the system level and separate the person from the defect.

• Present aggregate unit-level data to the committee with a run chart and a short learning narrative: what we tested, what worked, what failed, what we changed. Do not name individuals in a quality forum; that is a just-culture violation and it will suppress future reporting.
• Escalate the supply defect with data (stock-out days, missed doses of practice) to materials management - the fix lives there, and naming the accountable department is not blame, it is architecture.
• Hardwire: add CHG availability to daily charge rounding, embed necessity review in the rounding template, and put the bundle into onboarding and annual competency so gains do not depend on this project.
• Address role ambiguity in policy, not in another course; if intensivists own necessity review, the physician champion must own the follow-through.
• Celebrate the process wins publicly - availability and audit rates first - because outcome rates lag and the team needs to see movement.

Judgment: if a specific clinician repeatedly bypasses the bundle after system fixes, that becomes a manager and peer-review matter, not an education matter. Route it accordingly and in confidence.