Strategies to enhance nurses' adherence to central line-associated bloodstream infection prevention bundles in the ICU setting: A systematic review.

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.