1. 2
Improving Infection Control
Practices: An Evidence-Based
Practice Project to Minimize the
Rate of Central Line-Associated
Bloodstream Infection (CLABSI)
“From data to action, our CLABSI prevention project is
dedicated to protecting patients and saving lives.”
Naseema Bibi
Fahad Suleman
Sawera Khan
Kaiful Ara
Saira Azhar
Shanza Anwar
Munaza Nasir
Sameer Kumar
Electives Preceptor: Kashif Saad 1
2. • Outline the agenda and goals of the project.
• Define CLABSI (Central Line-Associated Bloodstream Infection) and its clinical significance.
• Discuss the prevalence of CLABSI both internationally and nationally.
• Explore nursing theories applied to the CLABSI project.
• Explain the methodology used in the CLABSI project.
• Discuss about the objectives of electives evidence-based project.
• Present the results and outcomes of the project.
• Identify gaps and challenges encountered during the project.
• Discuss limitations of the project and areas for improvement.
• Provide recommendations for CLABSI prevention.
• Acknowledge contributions and support for the project.
OBJECTIVES
2
3. • To investigate how quality assurance practices contribute to the prevention of Central Line Associated
Bloodstream Infections (CLABSI).
• To evaluate adherence to infection control standards in central line procedures.
• To monitor clinical practices related to the insertion and maintenance of central lines.
• To assess the effectiveness of staff education and training programs in reducing CLABSI rates.
• To identify key strategies that minimize the risk of CLABSI in tertiary care settings.
• To enhance patient safety through improved infection prevention practices.
AGENDA
3
4. 2
GOALS
• Reduce the rate of CLABSI in ICU settings by implementing Recommended 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 settings.
• 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.
The major goals to conduct this project are:
4
5. 2
• 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 life-threatening infections, with a mortality rate of 12–25%, causing thousands of
deaths and billions in healthcare costs annually.
(Chen & Feliciano, 2024)
INTRODUCTION
5
5
6. CLABSI PREVALENCE
Rosenthal, V. D., Yin, R., Myatra, S. N., Memish, Z. A., Rodrigues, C., Kharbanda, M., ... & Jin, Z. (2023). Multinational prospective study of incidence and risk factors for
central-line–associated bloodstream infections in 728 intensive care units of 41 Asian, African, Eastern European, Latin American, and Middle Eastern countries over 24 years.
Infection Control & Hospital Epidemiology, 44(11), 1737-1747.
CLABSI
Rate(Per
1000
Central
lineDevice
days
)
6
US China India Pakistan Nepal Saudi arabia
0
2
4
6
8
10
12
14
16
18
0.87 1.5
3.56
17.1
1.57
4.59
CLABSI RATE PER 1000 CL DAYS
7. 2
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. (Rana, 2020)
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. (Hawes, 2022)
Ernestine Wiedenbach's Helping Art of Clinical Nursing Theory
5 7
8. 2
METHODOLOGY
01 Project Design
Quasi-experimental pre and post-test
02
Project Setting
ICU department, of Memon Medical Institute
Hospital, Karachi.
03 Project Duration
four weeks
02
02
02
04
05
06
Sample Size
32 Healthcare professionals
Sampling Technique
Convenience sampling technique
Project Population
Health Care Providers (HCP) of Intensive Care Unit
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9. 2
OBJECTIVES OF THE EVIDENCE BASED PROJECT
(EBP)
• 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. 9
10. 2
ELIGIBILITY CRITERIA
Inclusion Criteria
HCPs working in ICU department.
Having a minimum one year of experience.
Upholding degree/diploma of their field of work.
Are willing to participate in the study.
Exclusion criteria
HCPs with less than one year of experience
Not having a degree/diploma in their field of work
Nurses with temporary rotation to ICU department.
HCPS on leave during study duration.
DATA COLLECTION PROCEDURE
Data collection
procedure
Healthcare professionals completed a
baseline questionnaire to assess their
initial knowledge and practices.
Educational
Intervention
Training sessions were conducted
for all participants to provide
them with relevant education.
Post-test Assessment
Participants completed the same questionnaire used
in the pre-test to evaluate improvements in their
knowledge and practices after the intervention.
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12. 2
Survey checklist
OBSERVATIONAL CHECKLIST
A KNOWLEDGE YES NO NA COMMENTS
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.
8 Documentation of CVP care and site condition is complete and up-to-date 12
15. 0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
37.52%
87.90%
RESULTS
12
The mean analysis shows decrease in the average mean score from the Pre-Knowledge phase (1.848067) to the Post-
Knowledge phase (1.66987). This suggests that the learning intervention was effective, as participants showed improvement in
their understanding or performance after the session.
1.55
1.6
1.65
1.7
1.75
1.8
1.85
1.9
1.848067
1.66987
Evaluation of Knowledge
Pre Knowledge Mean Post Knowledge Mean Pre knowledge evaluation Post knowledge evaluation
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16. 2
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
67.75%
91%
The mean analysis shows a decrease in the average mean score from the Pre-attitude phase (3.445313) to the Post-Knowledge
phase (3.414063). This suggests that the learning intervention was effective, as participants showed improvement in their
understanding or performance after the session.
3.39
3.4
3.41
3.42
3.43
3.44
3.45
3.445313
3.414063
Evaluation of Attitude
Pre Attitude Mean Pre Attitude
Post Attitude Mean Post Attitude
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17. 2
75.00%
80.00%
85.00%
90.00%
95.00%
100.00%
81.62%
94.46%
1.55
1.6
1.65
1.7
1.75
1.8
1.85
1.9
1.84375
1.65437
The mean analysis shows an decrease in the average mean score from the Pre-attitude phase (1.84375) to the Post-Knowledge
phase (1.65437). This suggests that the learning intervention was effective, as participants showed improvement in their
understanding or performance after the session.
Physician's pre and post evaluation of behavior and practices
Pre physician
practice Mean
Post physician
practice Mean
Physicians' pre-
evaluation of behavior
and practice
Physicians post
evaluation of behavior
and practice
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18. 2
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
60.20%
86.40%
1.4
1.45
1.5
1.55
1.6
1.65
1.6
1.475
The mean analysis shows an decrease in the average mean score from the Pre-attitude phase (1.6) to the Post-Knowledge phase
(1.475). This suggests that the learning intervention was effective, as participants showed improvement in their understanding
or performance after the session.
HCPs pre and post evaluation of behaviour and practices
Pre HCPS practice
Mean
Post HCPS practice
Mean
HCPS pre-evaluation
of behavior and
practices
HCPS post evaluation
of behavior and
practices
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19. 2
86.14%
86.16%
86.18%
86.20%
86.22%
86.24%
86.26%
86.28%
86.30%
86.32%
86.30%
86.20%
The analysis shows a very slight decrease in the average score from the Pre-Source of Information phase (1.135417) to the
Post-Source of Information phase (1.13212). This minimal change suggests that there was little to no significant shift in the
source of information participants relied on after the intervention or learning process.
1.13
1.131
1.132
1.133
1.134
1.135
1.136
1.135417
1.13212
Evaluation for source of information
Pre source of information
mean
Post source of information
mean
Pre evaluation
for source of
information
Post evaluation for
source of
information
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20. 2
Number of patient
with CVP
Alive (64%) Expiry (36.3%)
Days of CVP 1-5 days (46%) 6-10 days (23%) 10 or above (15%)
Site Juglar (0%) Subclavicle (0%) Femoral (100%)
Blood culture test Before CVP insertion
(27%)
During CVP
insertion (0)
After CVP removal
(0)
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DATA COLLECTED FROM HIMS
22. LIMITATIONS
• Hospital has guidelines on CLABSI prevention and CVP line care, but they were not always accessible when needed.
• 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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23. 2
1. Site Selection
• Prefer subclavian site in adults (IA)
• Avoid femoral site where possible (I)
• Use ultrasound guidance to minimize complications (IB)
• Select site/device based on duration, risks, operator skill
(IB)
2. Hand Hygiene & Aseptic Technique
• Perform hand hygiene before and after insertion or
manipulation (IB)
• Maintain full aseptic technique (IB)
• Wear sterile gloves for insertion (IA) and guidewire
exchanges (II)
• Use clean or sterile gloves for dressing changes (IC)
3. Skin Antisepsis
• Use alcohol-based chlorhexidine (0.5–2% CHG with
70% alcohol) for site prep (IA)
• Let antiseptic dry completely before insertion (IB)
• Alternatives (if CHG contraindicated): 70% alcohol,
iodine, or iodophor (IA)
• No recommendation for use in infants <2 months (UI)
4. Maximum Barrier Precautions
• Use full sterile gown, gloves, cap, mask, and full body
drape (IB)
• Use sterile sleeve for PA catheter insertion (IB)
EVIDENCE BASED RECOMMENDATIONS
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24. 2
5. Daily Review of Line Necessity
• Assess daily for need; remove if no longer required (IA)
• Replace emergency-inserted CVCs within 48 hours (IB)
• Avoid routine replacement of catheters (IB)
• Do not remove for fever alone; evaluate clinically (II)
6. Hub Disinfection & Accessing
Catheters
• Use minimum lumens needed (IB)
• Disinfect hubs/connectors with CHG-alcohol, iodophor,
or 70% alcohol (IA)
• Access with sterile devices only (IA)
• Prefer split septum valves over mechanical (II)
7. Dressing Management
• Use transparent semipermeable dressing or sterile gauze
(IA)
• Change dressing if soiled, damp, or loose (IB)
• Do not use topical antibiotics, except on dialysis catheters
(IB)
• Avoid submerging catheter site in water; use waterproof
cover during showers (IB)
• Change transparent dressings every 7 days (IB)
• Use CHG-impregnated dressings if CLABSI rates are high
despite other measures (IB)
8. Tubing & IV Administration Sets
• Change tubing:
• Propofol: every 6–12 hours or when vial is changed (IA)
• Blood, blood products, lipids: within 24 hours (IB)
• Other continuous infusions: every 96 hours to 7 days (IA)
• No recommendation for intermittently used sets or
implantable ports (UI)
EVIDENCE BASED RECOMMENDATIONS
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25. 2
EVIDENCE BASED RECOMMENDATIONS
• Watch for fever, chills, or confusion signs of infection.
• Check the catheter site for redness, swelling, or pain.
• Look for poor blood flow or trouble drawing blood from the catheter.
• Take blood cultures from the catheter and a regular vein if infection is
suspected.
• Use sterile techniques when handling the catheter and changing dressings.
• Start antibiotics quickly and adjust based on culture results.
• Educate patients to report any redness, swelling, or pain around the catheter.
26
Assessment for CLABSI
26. 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.
ACKNOWLEDGEMENT
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27. 2
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.
REFERENCES
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