{"title":"Strategies to enhance nurses' adherence to central line-associated bloodstream infection prevention bundles in the ICU setting: A systematic review","authors":"Diaa Bou Hamdan RN, MSN , Sarah Hatahet RN, MSN , Heba Khalil RN, PhD , Khalil M. Yousef RN, PhD","doi":"10.1016/j.hrtlng.2025.02.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The incidence of central line-associated bloodstream infection (CLABSI) in the ICU continues to rise. Despite existing CLABSI bundles to prevent infections, adherence remains suboptimal.</div></div><div><h3>Objective</h3><div>To identify and synthesize the evidence about strategies used to enhance nurses’ adherence to CLABSI prevention bundles.</div></div><div><h3>Methods</h3><div>Five databases were searched: CINAHL, MEDLINE, PubMed, Cochrane Library, and SCOPUS. Eligible studies were those published between 2012–2024, and investigated the adherence to central line bundles and strategies to improve adherence in the ICU. Two reviewers independently screened, critically appraised, and extracted data using Joanna Briggs Institute tools. The review protocol was registered on PROSPERO (CRD42024513345).</div></div><div><h3>Results</h3><div>Seven studies met the inclusion criteria, including four quality improvement projects and three quasi-experimental studies. The studies ranged in quality from moderate to high, with scores between 68.75 %-88.88 %. These studies explored various strategies to enhance nurses' adherence to CLABSI prevention bundles. Strategies included education, leadership, and auditing/feedback mechanisms. Education was the primary strategy utilized and included simulation and online training. Active participation in decision making, transparency in sharing CLABSI outcome data, celebrating achievements, and electronic documentation were essential aspects of leadership support to promote adherence. Implementing these strategies led to significant improvements in nurses’ adherence to bundle (<0.01).</div></div><div><h3>Conclusion</h3><div>Education, leadership, and audit mechanisms improve adherence to CLABSI bundles. Yet, the current evidence lacks randomized controlled trails that can establish effectiveness of these strategies. Future research should also investigate the long-term effect of these strategies on adherence, and the influence of organizational culture on CLABSI bundle adherence.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"71 ","pages":"Pages 98-105"},"PeriodicalIF":2.4000,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart & Lung","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0147956325000366","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background
The incidence of central line-associated bloodstream infection (CLABSI) in the ICU continues to rise. Despite existing CLABSI bundles to prevent infections, adherence remains suboptimal.
Objective
To identify and synthesize the evidence about strategies used to enhance nurses’ adherence to CLABSI prevention bundles.
Methods
Five databases were searched: CINAHL, MEDLINE, PubMed, Cochrane Library, and SCOPUS. Eligible studies were those published between 2012–2024, and investigated the adherence to central line bundles and strategies to improve adherence in the ICU. Two reviewers independently screened, critically appraised, and extracted data using Joanna Briggs Institute tools. The review protocol was registered on PROSPERO (CRD42024513345).
Results
Seven studies met the inclusion criteria, including four quality improvement projects and three quasi-experimental studies. The studies ranged in quality from moderate to high, with scores between 68.75 %-88.88 %. These studies explored various strategies to enhance nurses' adherence to CLABSI prevention bundles. Strategies included education, leadership, and auditing/feedback mechanisms. Education was the primary strategy utilized and included simulation and online training. Active participation in decision making, transparency in sharing CLABSI outcome data, celebrating achievements, and electronic documentation were essential aspects of leadership support to promote adherence. Implementing these strategies led to significant improvements in nurses’ adherence to bundle (<0.01).
Conclusion
Education, leadership, and audit mechanisms improve adherence to CLABSI bundles. Yet, the current evidence lacks randomized controlled trails that can establish effectiveness of these strategies. Future research should also investigate the long-term effect of these strategies on adherence, and the influence of organizational culture on CLABSI bundle adherence.
期刊介绍：
Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders.
The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.
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