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Published on: July 13, 2019
Reducing Central Line-Associated Bloodstream Infections in the ICU: A Nurse-Led Evidence Based Quality Improvement
Lu-Xi Deng1,2, Li-Qing Yue1, Li-Na Zhang2
1Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Aim:
This quality improvement (QI) project aimed to develop, implement and evaluate a nurse-led, evidence-based central venous catheter (CVC) maintenance flowchart to reduce central line-associated bloodstream infection (CLABSI) rates across five adult intensive care units (ICUs).
Design:
A prospective, pre-post intervention QI project was conducted.
Methods:
A nurse-led, multidisciplinary expert panel systematically reviewed the literature and graded evidence using the Joanna Briggs Institute (JBI) system. Recommendations were further evaluated for Feasibility, Appropriateness, Meaningfulness and Effectiveness (FAME), resulting in the development of an evidence-based CVC Maintenance Flowchart. The flowchart was implemented across five ICUs comprising 116 beds and 267 nurses. Pre- and post-intervention data on CLABSI rates (per 1000 CVC-days), CVC utilisation and compliance with the maintenance bundle were collected and compared.
Results:
The mean CLABSI rate across five ICUs significantly decreased from 4.55 per 1000 CVC-days in the pre-intervention period to 1.68 per 1000 CVC-days in the post-intervention period (p < 0.001), representing a 63.2% reduction. Overall nurse adherence to the CVC maintenance flowchart components increased from a baseline average of 78% to 94.4% (p < 0.001). The central line utilisation ratio remained stable, indicating that the reduction in infections was attributable to improved care practices rather than decreased device usage.
Conclusions:
This nurse-led QI initiative was associated with a substantial reduction in CLABSI rates among ICU patients and improved adherence to CVC maintenance practices. The project demonstrates that empowering frontline nurses with a structured implementation framework can bridge the gap between evidence and clinical practice, thereby enhancing patient safety in the ICU.
Implications For Nursing Practice:
Structured, nurse-led implementation strategies help ICU nurses transform evidence-based CVC maintenance recommendations into consistent bedside practices and may provide a practical framework for improving other nurse-sensitive clinical outcomes.
Patient Or Public Contribution:
Patients or members of the public were not involved in the design, conduct or reporting of this study.
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