Nursing-Driven Excellence in Central Line Safety achieving Zero CLABSI

Central Venous Catheters (CVCs) are essential in ICU care but carry a significant risk of Central Line-Associated Bloodstream Infections (CLABSI). In January 2025, the ICU recorded a CLABSI rate of 4.77 per 1,000 line days, substantially exceeding the CDC benchmark of 0.8 per 1,000 line days. This increase posed serious patient safety concerns, leading to increased morbidity, prolonged hospital stay, higher treatment costs, and greater antibiotic utilization.

Baseline audits identified gaps in central line maintenance practices, including low compliance with hub disinfection (45%), disinfection of catheter hubs and lumens (56.5%), and aseptic non-touch technique (ANTT) during catheter hub handling (30.6%). Bedside observations and surveillance also revealed inconsistent “Scrub the Hub” practices, irregular lumen cleaning, and contamination risks associated with central line handling.

These findings highlighted the need for a structured quality improvement initiative to standardize central line maintenance practices and reduce CLABSI in the ICU.

• Reduce the incidence of CLABSI in ICU patients through improved central line maintenance practices.
• Achieve Zero CLABSI through standardized catheter hub and lumen care protocols.
• Improve compliance with “Scrub the Hub” practices before every catheter access.
• Ensure consistent cleaning and disinfection of catheter hubs, connectors, stopcocks, and medication ports every 8 hours.
• Strengthen nursing competency, supervision, compliance monitoring, and infection prevention practices.
• Enhance patient safety and quality of care while sustaining improvements through continuous audits and surveillance.

A multidisciplinary team comprising Infection Control, ICU Consultants, Nursing, and Quality representatives implemented a quality improvement project using the DMAIC (Define–Measure–Analyze–Improve–Control) methodology. Baseline data were collected through CLABSI surveillance, compliance audits, bedside observations, CCTV monitoring, and staff assessments.

Root cause analysis identified deficiencies in hub disinfection, lumen care, and aseptic handling practices. Key interventions included launching a “Scrub the Hub” campaign, intensive staff training and video demonstrations, implementation of a standardized 8-hourly lumen care protocol, disinfection of catheter hubs and medication ports using 2% chlorhexidine gluconate, use of dedicated gauze for each hub, and placement of sterile barriers beneath lumens to prevent contamination.

Senior nurses conducted bedside supervision, real-time coaching, and compliance monitoring through regular and unannounced audits. A recognition program (“HIC Champion Award”) was introduced to reinforce adherence and sustain behavioral change.

Continuous surveillance, feedback, and monitoring ensured ongoing compliance and long-term sustainability of best practices. These interventions resulted in a reduction of the CLABSI rate from 4.77 to 0 per 1,000 line days, with sustained zero CLABSI from November 2025 to May 2026.

The quality improvement initiative produced significant and sustained improvements in central line maintenance practices and patient safety outcomes. The ICU CLABSI rate decreased from 4.77 per 1,000 line days in January 2025 to 0 per 1,000 line days, achieving and sustaining Zero CLABSI from November 2025 through May 2026.

Compliance with key infection prevention practices improved substantially. Hub disinfection compliance increased from 45% to >95%, disinfection of catheter hubs and lumens improved from 56.5% to 100%, and compliance with aseptic non-touch technique (ANTT) increased from 30.6% to 100%.

The project established a standardized protocol for central line maintenance, strengthened staff accountability, and improved adherence to infection prevention measures. In addition to preventing bloodstream infections, the initiative contributed to reduced antibiotic utilization, shorter ICU stays, lower treatment costs, and enhanced patient safety.

Cross-functional collaboration among nursing staff, infection control professionals, and clinicians improved, creating a sustainable culture of quality and safety in the ICU.

Several challenges were encountered during implementation, including inconsistent staff adherence to central line maintenance practices during busy ICU shifts, high staff turnover requiring repeated training, initial resistance to practice changes, and the need for continuous surveillance and monitoring. Managing critically ill and immunocompromised patients with multiple invasive devices also increased the baseline risk of infection.

Critical success factors included strong leadership support from the Hospital Infection Control Committee, active involvement of ICU consultants and nursing leaders, and a multidisciplinary team approach. The “Scrub the Hub” campaign, regular training sessions, bedside coaching by senior nurses, unannounced audits, CCTV monitoring, and structured feedback mechanisms were instrumental in driving compliance.

Recognition initiatives such as the HIC Champion Award further motivated staff and reinforced sustained behavioral change. Continuous monitoring and data-driven decision-making ensured long-term sustainability of improvements.

Standardization of central line maintenance practices is essential for reducing CLABSI and improving patient safety. The project demonstrated that consistent adherence to evidence-based practices such as hub disinfection, aseptic handling, and regular lumen care can significantly reduce infection rates.

Sustained improvement requires ongoing education, leadership engagement, routine audits, and real-time feedback. Frontline nursing staff play a critical role in infection prevention, and their competency development, supervision, and recognition are key to long-term success.

The initiative also highlighted the value of multidisciplinary collaboration, data-driven surveillance, and accountability systems in creating a culture of safety. Embedding these practices into routine workflows supports sustainability and enhances organizational readiness for high-quality, safe patient care.