Reducing CLABSI in a Tertiary ICU: A Quasi-Experimental Study of a Layered Quality Improvement Initiative

Central line-associated bloodstream infections (CLABSI) present a major challenge in health care today. Achieving and maintaining significant reductions in CLABSI rates often requires complex, structured interventions; yet, real-world data from high-complexity settings remain scarce. This report outlines a quality improvement initiative and assesses its impact on CLABSI rates and procedural practices in a high-risk hospital setting.

We conducted a single-center, quasi-experimental pre-post study. The intervention involved a layered, multifaceted approach that included: (a) the "4E" (Engage, Educate, Execute, Evaluate) model as a framework for institutional change; (b) the implementation of a standardized CVC insertion checklist; (c) targeted education on evidence-based guidelines, including optimal site selection; and (d) direct observation with performance feedback. The preintervention group (n=169) included patients from July 2022 to June 2023, with data collected retrospectively. The post-intervention group (n=227) included patients from July 2023 to December 2024, with data collected prospectively.

Data analysis revealed a significant decline in the overall CLABSI rate from 12.43% before intervention to 3.52% afterward ( P <0.001). At the same time, procedural practices changed notably: jugular vein insertions decreased from 14.20% to 1.76%, while basilic vein insertions rose from 31.95% to 42.73%. Bivariate analyses identified key factors associated with CLABSI risk.

Implementing a structured, layered quality improvement approach was associated with a significant decrease in CLABSI rates. While the study design does not allow for isolating the effects of individual components-such as the 4E framework, the checklist, or the changes in insertion practices-the results strongly suggest that a systematic strategy which combines a guiding framework, practical tools, and adherence to evidence-based practices effectively enhances patient safety in complex clinical settings.