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central line-associated bloodstream infection, evidence-based practice, quality improvement



  1. Harlan, Melissa Dawn DNP, RN, ACNS-BC
  2. Kennell, Jamilyn Sue MSN, RN, OCN
  3. Lucas, Wendy MSN, RN, CCRN, CCNS, BMTCN
  4. Ren, Dianxu MD, PhD
  5. Tuite, Patricia K. PhD, RN, CCNS


Purpose: This clinical nurse specialist-led quality improvement project identified barriers to adherence to a bundle for central line maintenance and examined the relationship between increased bundle adherence and central line-associated bloodstream infections.


Project Description: Oncology and critical care nurses were surveyed to identify barriers to adherence to a bundle for central line maintenance. Targeted initiatives based on survey responses were implemented focusing on antimicrobial bathing, increasing confidence in an evidence-based bundle, and its ability to reduce infections. Adherence and central line-associated bloodstream infection rates were monitored at baseline and at 3, 9, and 15 months post intervention.


Outcomes: Adherence to bundle elements improved post intervention in 4 areas in critical care units: correctly labeling catheter dressings, maintaining an occlusive dressing, clamping unused catheter lumens, and daily antimicrobial bathing. In oncology units, adherence improved in clamping unused lumens and daily antimicrobial bathing. At 9 months post intervention, infection rates decreased from 6.08 to 1.48 in critical care units and 3.13 to 0.30 in oncology units.


Conclusions: Identifying unit-specific barriers to adherence to bundles for central line maintenance and implementing targeted initiatives to reduce barriers increase adherence and prevent central line infections.