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Updated: Jun 4, 2026
A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Elimination of central-venous-catheter-related bloodstream infections from the intensive care unit
Andrew G Longmate1, Kirsteen S Ellis, Louise Boyle
1Intensive Care Unit, Stirling Royal Infirmary, NHS Forth Valley, Stirling FK8 2AU, UK. alongmate@nhs.net
Insights
Central-venous-catheter (CVC)-related bloodstream infections (CRBSI) were significantly reduced in an intensive care unit (ICU). Interventions led to a drop from 3.4 to 0 CRBSI episodes per 1000 patient days.
Area of Science:
- Healthcare Quality Improvement
- Infection Prevention and Control
- Critical Care Medicine
Background:
- Central-venous-catheter (CVC)-related bloodstream infection (CRBSI) poses significant risks in intensive care units (ICUs).
- Consistent application of evidence-based interventions to prevent CRBSI remains a challenge in clinical practice.
Purpose of the Study:
- To implement and evaluate interventions aimed at reducing CRBSI rates in an ICU setting.
- To assess the effectiveness of a quality improvement approach in enhancing patient safety and reducing healthcare-associated infections.
Main Methods:
- A 4-year quality improvement initiative was undertaken in an ICU, focusing on infection surveillance and implementing bundles of care for CVC insertion and maintenance.
- Educational interventions supported the implementation of care bundles.
- Statistical process control charts were used to monitor care processes and outcomes.
Main Results:
- The annual CRBSI rate decreased from 3.4 to 0 episodes per 1000 patient days.
- Zero CRBSI episodes were recorded during the final 19 months of the study period.
- Significant improvements in care processes and outcomes were observed.
Conclusions:
- A substantial reduction in CRBSI was achieved in a UK ICU for the first time.
- Simplifying interventions, measuring outcomes, and providing feedback were key to success.
- The described quality improvement strategies are recommended for broader consideration in healthcare settings.
Introduction:
Central-venous-catheter (CVC)-related bloodstream infection (CRBSI) is a complication of intensive care stay which can have important adverse consequences for both patient and institution. There are a number of evidence-based interventions that reduce CRBSI, but it is recognised that consistently applying the best evidence every time is a challenge.
Methods:
The authors set out to reduce CRBSI and introduced interventions in our intensive care unit (ICU) over a 4-year period using a quality improvement approach. In a setting supportive to change and improvement, the authors established infection surveillance and introduced bundles of care processes relating to insertion and maintenance of CVCs. The changes were supported by educational interventions. The authors measured care processes and outcomes, and used statistical process control charts to illustrate changes. The final 18 months of the work was performed in the context of a national safety improvement programme (The Scottish Patient Safety Programme).
Results:
Following interventions, the annual CRBSI rate fell from 3.4 to 0/1000 patient days with zero episodes during the final 19 months of the study.
Conclusions:
The authors describe a significant reduction in CRBSI for the first time in a UK ICU. The authors summarised and simplified what to do, measured and provided feedback on outcomes, and improved expectations of performance standards for care processes. The authors believe that these approaches are worthy of serious consideration elsewhere.
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