1.Established protocols for evaluating CVC placement duration and indications, leading to earlier catheter removal and reduced infection risk.

2.Improved unit infrastructure by adding hand sanitizers and providing training on antimicrobial materials, increasing their clinical use.

3.Standardized environmental cleaning and disinfection practices, and conducted random inspections.

4.Integrated CVC care standards into new employee training and regular quality assessments.

RESULTS

Team discussions identified main causes such as prolonged catheter placement, incomplete nursing care, and inadequate environmental cleanliness. Measures were proposed to address these issues: establishing standard operating procedures, increasing catheter labeling(Figure. 2), providing education and training on central line-associated bloodstream infections and hand hygiene for relevant healthcare professionals, changing the placement of disinfectant solutions, promoting the use of CHG gel dressings, using antimicrobial materials for CVP and intravenous caps, standardizing the placement of room items(Figure. 3), providing cognitive training for cleaning staff, and adding central line catheter care assessment questions. Through the implementation of preventive measures for central line-associated bloodstream infections over four months, the CLABSI rate decreased from 5.65‰ and 5.66‰ to 4.38‰ and 0‰, respectively. This resulted in reduced rates of missing daily care assessment, hand hygiene five moments, and routine cleaning process checklist, with improvement rates of 87.4%, 94.6%, and 60.9%, respectively. The application of empowerment theory in the CLABSI prevention project team members significantly boosted team morale, activity confidence, responsibility and honor, and team spirit(Figure. 4).

CONCLUSIONS

This study emphasizes the importance of nurses in preventing CLABSI in critical care units. Applying empowerment theory to a nurse-led CLABSI prevention project team enhances positive psychological outcomes among team members, improving overall performance. By collaborating with other healthcare professions to establish measures tailored to the unit's context, this approach effectively increases the improvement rates of daily care assessments, hand hygiene five moments, and routine cleaning process checklists while reducing CLABSI. This, in turn, decreases care costs, patient mortality rates, and hospitalization days, ultimately enhancing overall care quality and creating a win-win situation for patients, healthcare staff, and hospitals. We anticipate replicating this successful experience in other institutions to strengthen patient safety for critically ill patients in the future.

ACKNOWLEDGEMENT

The successful completion of this quality improvement project would not have been possible without the active participation of our team members, the support of unit supervisors, and the dedication of all our colleagues in the intensive care unit. It was the proactive planning by the nursing staff that led the infection control practitioners, physicians, care attendant, and cleaning staff to work together on this project, effectively reducing the bloodstream infection rate and thereby enhancing patient safety.