Evidence-based practice for preventing central line-associated bloodstream infections in intensive care units: An implementation study

Abstract Objectives: To implement and evaluate the effectiveness of evidence-based practices in preventing central line-associated bloodstream infections (CLABSI). Methods: This evidence-based implementation project employed the Joanna Briggs Institute (JBI) framework to improve prevention of CLABSI in 4 adult intensive care units (Surgical, Cardiac, Cardiothoracic, and Respiratory ICUs) at a tertiary hospital in Beijing from January 2023 to December 2024. The project included 3 phases: a baseline audit to evaluate adherence to CLABSI prevention guidelines and identify gaps in practice; development and implementation of the standardized central venous catheter (CVC) management protocols covering comprehensive staff training, regular simulation exercises, and continuous real-time monitoring through electronic health records; and a follow-up audit conducted one month post implementation to reevaluate protocol adherence and assess the intervention’s effectiveness, complemented by longitudinal tracking of CLABSI rates. The study enrolled all adult patients with CVCs and their attending health care professionals. Results: The implementation of evidence-based protocols resulted in full compliance (100%) across 3 critical procedural measures: sterile catheter utilization increased from 75% to 100%, intraprocedural hand hygiene adherence improved from 10% to 100%, and compliance with standardized 20-second mechanical skin antisepsis rose from 65% to 100%. Structural improvements included achieving 100% compliance with mandatory staff certification from a baseline of 0%, and tripling the frequency of simulation training participation from 25% to 75%. After the intervention, ICU nurses demonstrated a statistically significant improvement in knowledge scores related to CVC infection prevention (median score: 75 vs 65 preintervention; Z = −2.367, P = 0.018). The improvement was reflected in a right-shifted score distribution (Q1: 55 preintervention vs 63.8 postintervention; Q3: 80 preintervention vs 90 postintervention). CLABSI surveillance revealed differential outcomes across departments. The surgical ICU sustained a complete elimination of infections (0 cases/1000 catheter-days) from May 2023 to June 2024. Meanwhile, the respiratory ICU achieved temporary suppression with zero cases recorded between November 2023 and June 2024, followed by a resurgence in December 2024 (7.93 per 1000 catheter-days). The cardiac care unit maintained perfect adherence with no infections throughout the study period. In contrast, the critical care surgery unit continued to face challenges, with recurrent infections persisting at a rate of 7.93 per 1000 catheter-days by the end of the study. Conclusions: This study demonstrates that the implementation of evidence-based protocols can significantly reduce CLABSI incidence in ICUs while simultaneously enhancing health care workers’ compliance with and knowledge of infection control practices. The findings offer valuable insights for the development of effective ICU infection prevention strategies and underscore the necessity of ongoing improvement and innovation. Future research should focus on maintaining low CLABSI rates over the long term and on adapting these evidence-based practices to varied clinical settings.