Authors: (including presenting author): :
HO, HS1; LI, MNC2; WO, SY1; LAI, WS1; LAM, YF1; NG, ML1; Chow, C C1
Affiliation: :
1 Department of Medicine, Pamela Youde Nethersole Eastern Hospital 2. Department of Community Care Service, Queen Mary Hospital
Keyword 1: :
JBI, JBI PACES
Keyword 2: :
Catheter-Related Bloodstream Infections, CRBSI
Keyword 3: :
Central Venous Catheter, Dialysis catheter, CVC
Keyword 4: :
Central Venous Catheter care
Introduction: :
Catheter-related bloodstream infections (CRBSIs) remain a serious complication among hemodialysis patients with central venous catheters (CVCs), resulting in significant morbidity, mortality, prolonged hospital stays, and increased healthcare costs. Despite an existing CVC care bundle, infection rates surged by 500% — from 0.43 to 2.56 per 100 patient-months between Q3 and Q4 of 2024 in renal unit of Pamela Youde Nethersole Eastern Hospital. Strict compliance with antiseptic contact times, hand hygiene, and aseptic technique is essential to prevent bacterial entry and subsequent infections. This project applied the Joanna Briggs Institute (JBI) Evidence Implementation Framework to bridge the gap between evidence-based guidelines and nursing practice, enabling targeted strategies to boost adherence and reduce infection risk.
Objectives: :
To evaluate and improve nursing compliance with evidence-based CVC care guidelines for CRBSI prevention through JBI-guided implementation strategies.
Methodology: :
A structured three-phase implementation process was conducted using the JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tools. A baseline audit in June 2025 assessed 21 renal nurses’ adherence to 10 evidence-based criteria through chart reviews and direct observation. Based on audit findings, barrier analyses informed multifaceted interventions, including structured education sessions, competency assessments, workflow redesign, visual reminders (QR codes, timers), a buddy-champion system, leadership support, and real-time feedback audits. A follow-up audit in October 2025, using identical methods, evaluated compliance improvements and identified sustainability strategies.
Result & Outcome: :
Post-implementation, substantial improvements were observed across major CRBSI prevention practices. Compliance with rubbing catheter connection sites for a full 1 minute and wrapping them for ≥5 minutes before cap removal increased markedly following implementation of timers and workflow streamlining. Hub scrubbing before access strengthened through simulation-based training and visual reminders. Dressing changes, 0.5% chlorhexidine skin preparation, antimicrobial dressings, and documentation maintained 100% compliance. Aseptic technique during dressing removal and hand hygiene adherence improved significantly with education, peer support, and audit feedback. One criterion remained below the 85% benchmark, highlighting the need for ongoing monitoring. In conclusion, the JBI evidence-based implementation project effectively improved nurses’ adherence to CVC care guidelines, aligning clinical practice more closely with CRBSI prevention standards. Combined audit-feedback, targeted education, workflow optimization, and leadership engagement successfully promoted and sustained best practice in the hemodialysis setting. Continuation of periodic audits, staff development, and integration of CRBSI indicators into routine monitoring are essential for ongoing quality improvement.
