Nurse-led, multidisciplinary strategies to reduce central line-associated bloodstream infections: Parenteral nutrition stewardship and central venous access device maintenance.

BACKGROUND

Central line-associated bloodstream infections (CLABSIs) remain a major source of preventable patient harm and are associated with increased mortality, longer hospital stays, and higher health care costs. Reducing central venous access device (CVAD) utilization and improving line maintenance practices are key strategies for prevention.

PURPOSE: To reduce CLABSIs through a nurse-led, multidisciplinary initiative focused on parenteral nutrition (PN) stewardship, CVAD maintenance, and shared accountability for line necessity and care.

METHODS

Using Plan-Do-Study-Act cycles, an interprofessional team implemented a PN clinical decision tree, standardized PN administration kit, targeted nursing education, daily multidisciplinary line rounds, and real-time escalation processes. Outcomes included CLABSI Standardized Infection Ratio (SIR), Standardized Utilization Ratio (SUR), PN-related CLABSIs, and adherence to line care practices.

RESULTS

The initiative was associated with a 46% reduction in CLABSI SIR (1.165-0.632), an 11.7% reduction in CVAD utilization (SUR 0.479-0.423; P < .001), and a decrease in PN-related CLABSIs from 45% to 12.5% of all CLABSI cases. Process-related issues identified during rounds decreased from 32.73% to 26.11%.

CONCLUSIONS

A nurse-led, multidisciplinary approach combining PN stewardship, standardized CVAD care, and real-time feedback improved patient safety and reduced CLABSI risk. The model offers a sustainable, replicable strategy for infection prevention.