Outcomes of Using Nursing Practice Guidelines for Prevention of Central Line-Associated Bloodstream Infections in Critically Ill Patients: A Comparative Study
DOI:
https://doi.org/10.31674/mjn.2026.v17i04.014Abstract
Background: Central Line-Associated Bloodstream Infections (CLABSI) are a major complication in critically ill medical patients who receive central line catheter insertion. Therefore, Nursing Practice Guidelines (NPG) are needed. Objectives: This study aimed to compare the incidence of CLABSI between the intervention group and the standard care group. Methods: The research design was a comparative study. A total of 92 critically ill medical patients were recruited and assigned to the standard care group (n = 46), which received only standardized care, and the intervention group (n = 46), which received the NPG. The research instruments included: 1) the NPG for preventing CLABSI, 2) the patient data and clinical outcomes recording forms, 3) the nursing practice assessment forms, and 4) the satisfaction assessment forms. The research was conducted in the medical intensive care unit of a tertiary hospital. Data analysis was performed using descriptive statistics, Chi-Square tests, and relative risk ratio. Results: The intervention group had a CLABSI incidence rate of 0.48 per 1,000 C-line days, compared with 3.25 per 1,000 C-line days in the standard care group. Moreover, the intervention group reduced the risk of CLABSI by 89.5% (p <0.05). Professional nurses adhered correctly and comprehensively to the guidelines in over 80% of all components with high levels of satisfaction (M=4.58, SD=0.32). Conclusion: The findings suggest that consistent adherence to NPGs can substantially reduce preventable infections and improve patient safety.
Keywords:
Central Line-Associated Bloodstream Infections;, Critically Ill Medical Patients; , Nursing Practice GuidelinesDownloads
References
Akyol, E., & Çavdar, İ. (2022). The impact of care bundle approach in preventing central line-associated bloodstream infections in surgical intensive care units. Turkish Journal of Intensive Care, 20(3), 138-147. https://doi.org/10.4274/tybd.galenos.2021.44154
Atia, G. (2020). Effect of central venous catheter care bundle implementation on outcomes of critically ill Patients. Evidence-Based Nursing Research, 2(1), 28-39. https://doi.org/10.47104/ebnrojs3.v2i1.93
Buetti, N., Marschall, J., Drees, M., Fakih, M. G., Hadaway, L., Maragakis, L. L., Monsees, E., Novosad, S., O’Grady, N. P., & Rupp, M. E. (2022). Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 update. Infection Control & Hospital Epidemiology, 43(5), 553-569. https://doi.org/10.1017/ice.2022.87
Buetti, N., Mimoz, O., Schwebel, C., Ruckly, S., Castry, M., Dupuis, C., Souweine, B., Lucet, J.-C., & Timsit, J.-F. (2021). Insertion site and infection risk among peripheral arterial catheters. American Journal of Respiratory and Critical Care Medicine, 203(5), 630-633. https://doi.org/10.1164/rccm.202007-3008LE
Chovanec, K., Arsene, C., Gomez, C., Brixey, M., Tolles, D., Galliers, J. W., Kopaniasz, R., Bobash, T., & Goodwin, L. (2021). Association of CLABSI with hospital length of stay, readmission rates, and mortality: A retrospective review. Worldviews on Evidence‐Based Nursing, 18(6), 332-338. https://doi.org/10.1111/wvn.12548
Cribbs, K. A. (2020). Investigating the Impact of the Nursing Practice Environment (NPE) on Central Line-Associated Bloodstream Infections (CLABSI) among Older Adults in the Intensive Care Unit (ICU). https://academicworks.cuny.edu/sph_etds/44
Darayon, R., Komet, O., & Nuchu, Y. (2024). Incidence of central line-associated bloodstream infection: A 6-year report in the Medical Intensive Care Unit at a University Hospital. Thai Journal of Nursing and Midwifery Practice, 11(1), 53-63. https://he02.tci-thaijo.org/index.php/apnj/article/view/266778
Davis, T., Wittmann, S., Prairie, B. A., Dugan, N., Reiser, P., Goclano, L., & Dziobak, R. (2024). Implementing a compliance monitoring process to promote chlorhexidine gluconate bathing and hand hygiene: An initiative to decrease central line–associated bloodstream infections. Patient Safety, 6(1), Article 121071. https://doi.org/10.33940/001c.121071
Eyuboglu, M. O., İlçe, A. Ö., & Soysal, G. E. (2024). Effectiveness of transparent dressing with chlorhexidine gluconate for central venous catheter care in the Intensive Care Unit: A case control study. Sağlık Bakım ve Rehabilitasyon Dergisi, 3(2), 1-12. https://dergipark.org.tr/tr/download/article-file/4100460
Haddadin, Y., Annamaraju, P., & Regunath, H. (2017). Central line–associated blood stream infections. In StatPearls [Internet]. StatPearls Publishing.
Hernández-Aceituno, A., Vega-Costa, V., Ruiz-Álvarez, M., Figuerola-Tejerina, A., Méndez-Hernández, R., & Ramasco-Rueda, F. (2020). Effectiveness of a bundle of measures for reducing central line-associated bloodstream infections. Revista Española de Anestesiología y Reanimación (English Edition), 67(5), 227-236. https://doi.org/10.1016/j.redar.2019.11.014
Kuroki, M., Short, A. C., & Coombs, L. A. (2025). Chlorhexidine gluconate treatment adherence among nurses and patients to reduce central line–associated bloodstream infections. Clinical Journal of Oncology Nursing, 29(2), E37-E46. https://doi.org/10.1188/25.CJON.E37-E46
Lafuente Cabrero, E., Terradas Robledo, R., Civit Cuñado, A., García Sardelli, D., Hidalgo López, C., Giro Formatger, D., Lacueva Perez, L., Esquinas López, C., & Tortosa Moreno, A. (2023). Risk factors of catheter-associated bloodstream infection: Systematic review and meta-analysis. PLOS One, 18(3), Article e0282290. https://doi.org/10.1371/journal.pone.0282290
Lau, F., & Holbrook, A. (2017). Methods for comparative studies. In Handbook of eHealth evaluation: An Evidence-based approach. University of Victoria.
Madran, B., Keske, Ş., Bakır, V. O., & Ergönül, Ö. (2022). The effectiveness of bundle applications in the prevention of central line-associated bloodstream infections: Nine years of observation. Infectious Diseases & Clinical Microbiology, 4(1), 40-46. https://doi.org/10.36519/idcm.2022.114
Mostafa, F. A., Alnafee, K., Al Shanqiti, K., Siddiq, N., Alshuhri, S., & Badawi, D. (2022). Reducing central-line–associated bloodstream infections (CLABSI): An improvement project in a specialized tertiary hospital. Global Journal on Quality and Safety in Healthcare, 5(4), 84-92. https://doi.org/10.36401/JQSH-22-4
O’Grady, N. P. (2023). Prevention of central line–associated bloodstream infections. New England Journal of Medicine, 389(12), 1121-1131. https://doi.org/10.1056/NEJMra2213296
Phaisantum, P. (2022). The effectiveness of Nursing care protocol for patients with central line of professional nurses. Journal of Nursing Division, 49(2), 86-99. https://he01.tci-thaijo.org/index.php/JND/article/download/264817/178519/1087884
Rajandra, A., Yunos, N. a. M., Teo, C. H., Kukreja, A., Suhaimi, N. A., Mohd Razali, S. Z., Basri, S., Teh, C. S. J., Leong, C. L., & Ismail, I. (2025). Incidence, compliance, and risk factor associated with central line-associated bloodstream infection (CLABSI) in Intensive Care Unit (ICU) patients: A multicenter study in an upper middle-income country. Antibiotics, 14(3), Article 271. https://doi.org/10.3390/antibiotics14030271
Rosenthal, V. D., Memish, Z. A., Shweta, F., Bearman, G., & Lutwick, L. I. (2024). Preventing central line-associated bloodstream infections: A position paper of the International Society for Infectious Diseases, 2024 update. International Journal of Infectious Diseases, 150, Article 107290. https://doi.org/10.1016/j.ijid.2024.107290
Sabharwal, S., Patel, V., Nijjer, S. S., Kirresh, A., Darzi, A., Chambers, J. C., ... & Athanasiou, T. (2013). Guidelines in cardiac clinical practice: evaluation of their methodological quality using the AGREE II instrument. Journal of the Royal Society of Medicine, 106(8), 315-322. https://doi.org/10.1177/0141076813486261
Suwannakeeree, W., & Jullmusi, O. (2021). Prevention of central line-associated bloodstream infection. Journal of Nursing and Health Sciences, 15(2), 14-26. https://doi.org/10.1016/j.idc.2021.07.004
Takeshita, J., Tachibana, K., Nakajima, Y., & Shime, N. (2022). Incidence of catheter-related bloodstream infections following ultrasound-guided central venous catheterization: A systematic review and meta-analysis. BMC Infectious Diseases, 22(1), Article 772. https://doi.org/10.1186/s12879-022-07760-1
Thupboocha, J. (2020). Development of central line associated bloodstream infection (CLABSI) prevention model. Buddhachinaraj Medical Journal, 37(2), 149-158. https://he01.tci-thaijo.org/index.php/pnc/article/view/261386
Toney-Butler, T. J., Gasner, A., & Carver, N. (2023). Hand hygiene. In Stat Pearls [Internet]. Stat Pearls Publishing.
Uppanisakorn, S., Pochanakij, C., & Boonyarat, J. (2018). The effects of the program to prevent central line-associated bloodstream infection (CLABSI) in Medical ICU. Journal of Medical Sciences Region 11, 32(2), 1095-1104. https://he02.tci-thaijo.org/index.php/Reg11MedJ/article/view/156874/113804
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 The Malaysian Journal of Nursing (MJN)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
