Reducing CLABSI in a Tertiary ICU: A Quasi-Experimental Study of a Layered Quality Improvement Initiative

Introduction: – Central line-associated bloodstream infections (CLABSI) present a major challenge in health care today. Achieving and maintaining significant reductions in CLABSI rates often requires complex, structured interventions; yet, real-world data from high-complexity settings remain scarce. This report outlines a quality improvement initiative and assesses its impact on CLABSI rates and procedural practices in a high-risk hospital setting. Materials and Methods: – We conducted a single-center, quasi-experimental pre-post study. The intervention involved a layered, multifaceted approach that included: (a) the “4E” (Engage, Educate, Execute, Evaluate) model as a framework for institutional change; (b) the implementation of a standardized CVC insertion checklist; (c) targeted education on evidence-based guidelines, including optimal site selection; and (d) direct observation with performance feedback. The preintervention group (n=169) included patients from July 2022 to June 2023, with data collected retrospectively. The post-intervention group (n=227) included patients from July 2023 to December 2024, with data collected prospectively. Results: – Data analysis revealed a significant decline in the overall CLABSI rate from 12.43% before intervention to 3.52% afterward (P<0.001). At the same time, procedural practices changed notably: jugular vein insertions decreased from 14.20% to 1.76%, while basilic vein insertions rose from 31.95% to 42.73%. Bivariate analyses identified key factors associated with CLABSI risk. Conclusion: – Implementing a structured, layered quality improvement approach was associated with a significant decrease in CLABSI rates. While the study design does not allow for isolating the effects of individual components—such as the 4E framework, the checklist, or the changes in insertion practices—the results strongly suggest that a systematic strategy which combines a guiding framework, practical tools, and adherence to evidence-based practices effectively enhances patient safety in complex clinical settings.