Central venous catheters (CVCs) are widely used in intensive care, chemotherapy, and long-term intravenous therapy. However, CVC-related bloodstream infections (CRBSIs) are serious complications that increase hospitalization duration and medical costs and can lead to severe infections or even be life-threatening. Therefore, effective prevention of CRBSI is a critical issue in clinical nursing.
In recent years, bundled nursing interventions have emerged as a systematic, standardized, and targeted strategy to prevent CRBSI. This study aims to explore the clinical effectiveness of bundled nursing interventions in reducing CRBSI incidence.
This study selected a total of 200 patients who underwent central venous catheter (CVC) placement at a tertiary hospital between January 2022 and December 2023. Patients were randomly assigned using a computerized random number table into a control group (n = 100) and an experimental group (n = 100).
To ensure a representative and consistent sample, specific inclusion and exclusion criteria were established.
Inclusion Criteria:
1) Age ≥ 18 years;
2) Undergoing CVC placement with an expected duration of ≥7 days;
3) No diagnosis of severe immunodeficiency or hematologic malignancy during the study period;
4) No history of central line-associated bloodstream infections (CLABSIs) or current anti-infective therapy;
5) Provided signed informed consent to participate in the study.
Exclusion Criteria:
1) History of severe systemic infectious diseases, such as sepsis, HIV, or tuberculosis;
2) Withdrawal from treatment or lost to follow-up during the study period;
3) Presence of pre-existing local infection at the catheter insertion site;
4) High-risk comorbidities, such as uncontrolled diabetes, chronic renal failure, or advanced cancer;
5) Cognitive impairment or communication barriers that could affect compliance.
Baseline characteristics such as age, sex, underlying diseases, catheterization site, and catheter dwell time were recorded and compared between the two groups to ensure no significant differences at baseline.
This study employed a randomized controlled trial (RCT) design. The control group received routine nursing care, which included basic hygiene measures, standard catheter maintenance, and general observation. In contrast, the experimental group received bundled nursing interventions in addition to standard care. These interventions were comprehensive, evidence-based measures aimed at reducing the incidence of catheter-related bloodstream infections (CRBSIs).
The bundled intervention protocol is comprised of five core components and is implemented through a multidisciplinary approach.
1) Strict Hand Hygiene Management:
2) Aseptic Operation Standards:
1) Dressing Management:
2) Catheter Flushing and Locking:
3) Catheter Site Monitoring:
1) Health Literacy and Risk Communication:
2) Individualized Care Plans:
1) Formation of a CVC Care Team:
2) Continuous Professional Development:
1) Rational Antibiotic Usage:
2) Surveillance of Antimicrobial Resistance:
The incidence of central venous catheter-related bloodstream infections (CRBSIs) was significantly lower in the experimental group (see
This reduction in infection incidence not only reflects improved adherence to aseptic protocols but also underscores the potential of standardized nursing strategies to minimize preventable complications.
Group |
Number of Cases (n) |
CRBSI Cases (n) |
CRBSI Incidence (%) |
Control Group |
100 |
12 |
12.0 |
Experimental Group |
100 |
3 |
3.0 |
Note: CRBSI = Central venous catheter-related bloodstream infection. The incidence rate was significantly lower in the experimental group (3.0%) compared to the control group (12.0%), indicating the effectiveness of bundled nursing interventions (P < 0.05).
Nursing satisfaction was assessed using a standardized patient satisfaction questionnaire, which included items on communication, technical skills, responsiveness, and perceived safety of care. The experimental group reported significantly higher satisfaction scores across all dimensions compared to the control group (P < 0.05).
This improvement can be attributed to better nurse-patient communication, enhanced education regarding catheter care, and the professional and coordinated appearance of the interdisciplinary nursing team. The involvement of patients in care decisions and consistent feedback mechanisms also contributed to increased satisfaction levels.
The average length of hospital stay for patients in the experimental group was 7.2 ± 1.5 days (see
Outcome |
Control Group (Mean ± SD) |
Experimental Group (Mean ± SD) |
P-value |
Length of hospital stay (days) |
9.8 ± 2.1 |
7.2 ± 1.5 |
<0.05 |
Duration of antibiotic therapy (days) |
6.3 ± 1.7 |
4.1 ± 1.0 |
<0.05 |
Note: Data are presented as mean ± standard deviation. Patients in the experimental group had significantly shorter hospital stays and lower duration of antibiotic therapy than those in the control group (P < 0.05), suggesting improved recovery and reduced complications due to bundled nursing interventions.
These differences suggest that the bundled intervention group achieved faster recovery, experienced fewer complications, and required less pharmacological intervention. Not only do these outcomes improve patient experience and clinical efficiency, but they also result in significant reductions in hospital resource utilization and treatment costs.
The findings of this study confirm that the application of bundled nursing interventions significantly reduces the incidence of central venous catheter-related bloodstream infections (CRBSIs), improves patient satisfaction, shortens the length of hospital stays, and decreases the need for antibiotics. These results not only reflect improved clinical outcomes but also underscore the broader implications of nursing interventions for patient safety and healthcare system efficiency.
The occurrence of CRBSI is intricately associated with the degree of adherence to aseptic techniques during catheter insertion and subsequent maintenance
Notably, the results are consistent with prior multicenter studies that have shown up to 60% reductions in CRBSI incidence following the implementation of evidence-based care bundles
Beyond infection control, bundled interventions contributed to the overall improvement of nursing quality
Patients and their families became more aware of infection risks and self-care responsibilities, which strengthened compliance and cooperation
These improvements reflect the increasing recognition of nurses’ role not only as caregivers but as pivotal contributors to quality improvement and patient education initiatives.
Hospital-acquired infections such as CRBSI often lead to prolonged hospitalization, increased antibiotic consumption, and elevated healthcare costs
From a healthcare management perspective, this not only improves bed turnover efficiency but also contributes to antibiotic stewardship—a critical global health priority given the rising threat of antimicrobial resistance (AMR)
While the results of this study are promising, several limitations should be acknowledged:
1) Sample Size and Scope: The study was conducted at a single institution with a limited sample size, which may restrict the generalizability of findings. Larger, multicenter studies are needed to validate and extend these results across diverse clinical settings.
2) Study Design: Although randomized, elements of retrospective data collection may have introduced potential recall or selection bias. Future studies should adopt prospective, double-blinded, randomized controlled trials to enhance causal inference and eliminate confounding variables.
3) Heterogeneity of Patient Populations: The current intervention was standardized, but patients present varying risks depending on comorbidities, immune status, and catheter type. Future research should explore stratified or personalized intervention bundles that adjust to patient-specific risk profiles.
4) Long-term Outcomes: The study focused on short-term clinical indicators. Long-term follow-up regarding catheter patency, recurrence of infections, readmissions, and patient-reported outcomes (e.g. quality of life) would enrich the evaluation of bundled interventions.
5) Implementation Challenges: The success of bundled care depends heavily on institutional support, adequate staffing, continuous training, and monitoring. Further investigation is needed into the cost-effectiveness and sustainability of such interventions, particularly in resource-limited settings.
This study provides compelling evidence that bundled nursing interventions represent an effective and feasible strategy to reduce the incidence of CRBSI, improve patient safety, enhance satisfaction, and optimize healthcare resource utilization. The bundled approach—emphasizing aseptic technique, catheter care standardization, health education, team collaboration, and rational antibiotic use—demonstrated measurable improvements in clinical and nursing outcomes.
Given the increasing complexity of patient care and the rising burden of hospital-acquired infections, implementing bundled nursing strategies should be considered a best practice in CVC management. Clinical nursing departments are encouraged to institutionalize such protocols and support continuous quality improvement through training, audit, and interdisciplinary teamwork.
Future efforts should focus on the development of patient-centered, adaptive intervention models, as well as the integration of digital technologies (e.g. electronic alerts and infection surveillance systems) to enhance adherence and early detection. In parallel, investment in nursing education and leadership development will be critical to sustain high-quality care practices.
Ultimately, bundled nursing interventions not only contribute to the reduction of CRBSI, but also symbolize a paradigm shift toward proactive, evidence-based, and collaborative nursing care in modern clinical practice.
*First author.
#Corresponding author.