Improving Infection Control Practices: An

Evidence-Based Practice Project Bloodstream Naseema Bibi

Infections (CLABSI) to Minimize the Rate of Fahad Suleman
Central Line-Associated
Sawera Khan

“From data to action, our CLABSI prevention project is dedicated to Kaiful Ara
protecting patients and saving lives.”
Saira Azhar

Shanza Anwar

Munaza Nasir

Sameer Kumar

1 22 April 2025
 Agenda

This research investigates how quality assurance practices help prevent Central Line-Associated Bloodstream
Infections (CLABSI) in tertiary care hospitals. It focuses on adherence to infection control standards, monitoring
clinical procedures, and staff education to minimize CLABSI risks and improve patient safety.

The major goals to conduct this project are:

 Reduce the rate of CLABSI in the ICU by implementing improved infection control practices.
 Enhance staff compliance with infection prevention protocols through education and training.
 Establish a standardized approach for central line insertion and maintenance across the ICU.
 Promote a culture of safety by involving both healthcare workers and patients in infection prevention efforts.
 Ensure continuous monitoring and evaluation of infection rates to assess the impact of the implemented
practices.
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 Objectives
• The study aims to assess the current knowledge, practices, and attitudes of ICU nursing
staff regarding central line-associated bloodstream infections (CLABSI) using a per-
assessment questionnaire.

• Implement a training program to improve ICU nursing staff's knowledge, attitude, and
practices in preventing CLABSI and reducing infection rates in intensive care settings.

• The study evaluates the post-assessment of ICU nursing staff's knowledge, practices, and
attitudes regarding CLABSI after implementing strategies to reduce the increasing rate of
infection in the ICU.

• Develop proficiency in practicing EBP by introducing standardized guidelines of

preventing the spread of CLABSI infection in ICU setting.

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 Introduction

• A central line bloodstream infection (CLABSI) occurs when bacteria or other germs enter the patient's
central line and then enter into their bloodstream. These infections are serious but can often be
successfully treated.

• CLABSI are among the deadliest infections, with a mortality rate of 12–25%, causing thousands of deaths
and billions in healthcare costs annually.

• While the prevalence in U.S. ICUs was 0.87 per 1,000 central line days in 2020, rates are much higher in
countries like Pakistan, where studies show CLABSI rates ranging from 5.0 to 17.1 per 1,000 device days.
• They are the second most preventable HAI, and have ranked as high as the 8th leading cause of death in
the U.S.
• Due to CMS policies and prevention efforts, CLABSI rates have declined significantly, with 18,000 ICU
cases reported in 2009.
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References: , T., & Eastman, A. L. (2018). Clabsi. Surgical Critical Care Therapy: A clinically oriented practical approach, 399-402.
 Nursing Theories applied to the project

Environmental Theory of Florence Nightingale

Florence Nightingale’s Environmental Theory emphasizes the role of cleanliness, sanitation, and
environmental factors in promoting health. In the context of preventing Central Line-Associated
Bloodstream Infections (CLABSI), her theory advocates for maintaining a sterile environment, using
proper techniques for central line care, and disinfecting high-touch surfaces. Nightingale’s holistic
approach also underscores the importance of mental, spiritual, and social support, along with thorough
documentation to ensure adherence to infection control practices.

Ernestine Wiedenbach's Helping Art of Clinical Nursing Theory

Ernestine Wiedenbach’s Helping Art of Clinical Nursing Theory emphasizes the nurse-patient relationship
in healthcare. In preventing CLABSI, it encourages nurses to assess patient risk, apply evidence-based
infection control practices, and continuously evaluate intervention effectiveness. The theory advocates for
standardized central line care, accountability, and ongoing education on the latest prevention methods. It
also highlights the importance of patient-centered care and teamwork in achieving optimal outcomes.

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Methodology 01 Project Design
Quasi-experimental pre and post-test

02 Project Setting
ICU department, of Memon Medical Institute
02 Hospital, Karachi.

03 Project Duration
four weeks
04 Sample size
32 Healthcare professionals
02 Sampling technique
05
02 Convenience sampling technique
Project population
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Health Care Providers (HCP) of Intensive Care Unit
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 Eligibility criteria

Inclusion Criteria Exclusion criteria

HCPs working in ICU department. HCPs with less than one year of experience
Having a minimum one year of experience. Not having a degree/diploma in their field of work
Upholding degree/diploma of their field of work. Nurses with temporary rotation to ICU department.
Are willing to participate in the study. HCPS on leave during study duration.

Data collection procedure

Data collection procedure Educational Intervention Post-test Assessment

Nurses completed a baseline questionnaire Training sessions were conducted for Participants completed the same questionnaire used in the
to assess their initial knowledge and all participants to provide them with pre-test to evaluate improvements in their knowledge and
practices. relevant education. practices after the intervention.

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Strategies for project

1.Engaging Visual Aids

2.Interactive Sessions

3.Video Demonstrations

4.Role-playing Activities

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 Observation checklist
Survey
A KNOWLEDGE YES NO N\A COMMENTS

checklist
1. Staff can identify the proper indications for CVP line insertion.

2. Staff are aware of CLABSI risk factors related to CVP lines.

3. Staff are trained in aseptic technique for CVP insertion.

4. CVP insertion is done following institutional or CDC guidelines.
5. Appropriate PPE is worn during CVP insertion and care.

B ATTITUDE
1 Staff demonstrate vigilance in maintaining a sterile field during CVP procedures.

2 Staff encourage compliance with hand hygiene before and after CVP handling.

3 Staff are cooperative with infection control audits and feedback.

C PRACTICE
1 Hand hygiene is performed before and after CVP line handling.

2 Maximal sterile barrier precautions are used during CVP insertion (mask, cap, sterile gloves, gown, and full body drape).

3 CVP insertion site is cleaned with appropriate antiseptic (e.g., chlorhexidine).

4 CVP dressing is changed per protocol (every 5–7 days or sooner if soiled/loose).

5 CVP lines are reviewed daily for necessity and removed promptly when no longer needed.

6 CVP ports are scrubbed with alcohol/chlorhexidine before access.

7 Sterile technique is maintained during CVP medication/fluid administration. 9

 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 Week 13

Observation for 70%

topic

Exchang
ideas with
group
62%
members

Meeting with
faculty and 20%
preceptor

Discussed with
10%
HOD and got
topic approved

Assessed 20%
knowledge ,attitud
e and practice

Conducted 95%

sessions and did

evaluation
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 16% 84%

Credentialing Compliance Percentage for Central Venous

Result Pressure (CVP) Line Insertion
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 Result
Evaluation of Knowledge Evaluation of attitude
100.00% 100.00%

90.00% 90.00%
91%
87.90%
80.00% 80.00%

70.00% 70.00%
68%
60.00% 60.00%

50.00% 50.00%

40.00% 40.00%
37.52%
30.00% 30.00%

20.00% 20.00%

10.00% 10.00%

0.00% 0.00%
Pre knowledge evaluation Post knowledge evaluation Pre Attitude Post Attitude

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 Physician's pre and post evaluation of HCPs pre and post evaluation of
behaviour and practices behaviour and practices

Result 100.00%

95.00%
100.00%
80.00%
60.00%
60.20%
86.40%

94.46% 40.00%
20.00%
90.00%
0.00%

85.00%

80.00% 81.62%

75.00%

Evaluation for source of information

86.30%
86.30%
86.26%
86.22%
86.18% 86.20%
86.14%

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 Gaps

Gaps

Inadequate Inadequate Professional Policy

awareness documentation negligence stagnation
of CLABSI
practices

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 Limitations
 Hospital has guidelines on CLABSI prevention and CVP line care, but they were not always
accessible when needed.

 Only one Infection Control Nurse (ICN) was available, and due to her workload, we couldn’t engage
with her as frequently as required.

 Staff had theoretical knowledge about CVP line insertion and CLABSI prevention but faced
challenges in consistent implementation.

 We did not have access to previous years of CLABSI audit data to compare with our current
findings.

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 Recommendations

 Assign dedicated and trained nursing staff for patients with central lines to ensure proper line care
and reduce CLABSI risk.

 Emphasize strict implementation of CLABSI prevention policies, especially during CVP line
insertion and maintenance.

 Ensure availability of necessary resources (e.g., sterile kits, antiseptics, PPE) to support safe CVP
line practices.

 Conduct regular audits and monitoring of CVP line care procedures to identify gaps and reinforce
compliance.

 Limit unnecessary handling of CVP lines by staff and restrict access to only trained personnel to
minimize infection risks.
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 Acknowledgment

I would like to extend my heartfelt gratitude to my esteemed teachers, the Head of Department, Sir
Altaf, Assistant Principal, Sir Junaid, Clinical Preceptor, Kashif Saad, and Clinical Supervisor, Sunita
Ali, for their unwavering guidance and support throughout my senior elective project. Their expertise,
insightful feedback, and encouragement have been instrumental in shaping my learning journey and
the successful outcomes of this project.

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 References

1. Khan, M., Ahmad, I. W., Waheed, M., Tahir, H., & Hurain, K. (2024). Knowledge, Attitude and Practice among Nurses Regarding
Prevention of Central Line Associated Bloodstream Infection in Tertiary Care Hospital of Peshawar: Prevention of Central Line Associated
Bloodstream Infections. Pakistan Journal of Health Sciences, 88-91.
2. Chen, L., & FELICIANO, E. (2024). Knowledge, Attitudes, and Behaviors of Intensive Care Unit Healthcare Workers in Preventing
Central Line-Associated Blood Stream Infections in Selected Hospitals of Zhejiang Province, China. International Journal of Frontiers in
Medicine, 6(5).
3. Al-Yateem, I. S. A. (2021). Knowledge, Behavior and Attitude of Nurses Regarding Prevention of Central Line Associated Blood Stream
Infections (Doctoral dissertation, Royal College of Surgeons in Ireland).
4. Chi, X. W., He, R., Wu, X. H., Wu, L. J., Yang, Y. L., & Huang, Z. (2024). Development of best evidence-based practice protocols for
central venous catheter placement and maintenance to reduce CLABSI. Medicine, 103(27), e38652.
5. Odada, D., Munyi, H., Gatuiku, J., Thuku, R., Nyandigisi, J., Wangui, A., ... & Adam, R. D. (2023). Reducing the rate of central line-
associated bloodstream infections; a quality improvement project. BMC Infectious Diseases, 23(1), 745.

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THANK YOU

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