Table 2.

Classification of Quality Improvement Interventions and Number of Studies

Quality Improvement Intervention(No. of Studies)	Definition and Examples
Education (n = 33)	Teaching lectures transmitting theoretical knowledge concerning CLABSI
	Monthly sessions or a single lecture concerning CLABSI epidemiology or preventive interventions Educational modules with pre- and posttest
Training (n = 4)	Training sessions for practical skills associated with CVC care and maintenance
	Personnel training for aseptic CVC insertion on patient simulators
Feedback (n = 20)	Reporting of CLABSI or care item compliance rates to ICU personnel
	Monthly reporting of infection rates at staff meetings Posters of improving prevention measure compliance or CLABSI rates
Clinical reminders (n = 15)	Reminders of optimal clinical practice strategically placed to improve awareness or application of prevention measures
	Posters advertising proper hand hygiene or monthly CLABSI rates A daily reminder per patient asking whether a CVC can be discontinued Stickers placed on CVCs or wearable lapel buttons reminding personnel of the importance of care processes Procedure fact sheets, flowcharts, algorithms, or daily goals sheet
Bundle (n = 11)	A short list of at least 2 IHI prevention measures to be used during CVC insertion and/or maintenance
	A bundle consists of 2–5 IHI care items A bundle does not contain quality improvement interventions aiming at improving compliance with prevention measures
Checklist (n = 18)	Checklist of bundled care item prevention measures to increase adherence to evidence-based infection prevention practices
	A checklist of 2–5 IHI care items is used during CVC insertion to improve adherence to a bundle of care items
Empowerment to stop procedure (n = 10)	Nurses are empowered to halt and restart CVC insertion care or maintenance when a prevention measure is not implemented correctly to ensure optimal catheter care
Surveillance: compliance monitoring (n = 12)	Nurses intermittently or continually supervise CVC insertion or maintenance prevention measures, with/without use of a bundle/checklist
Leader designation (n = 11)	A leader is designated to facilitate implementation of quality intervention processes by planning activities to improve awareness or introduction of bundled care items
Prepackaging of CVC materials (n = 16)	Use of a CVC cart or kit stocked with all necessary supplies to insert or maintain a central line
Infrastructure changes (n = 2)	Changes to hospital infrastructure to facilitate adherence to prevention measures
	Installation of hand-rub dispensers to lower the threshold for personnel to apply antiseptic hand hygiene
Organizational changes (n = 4)	Organizational changes in personnel staffing or duties to improve adherence to prevention measures
	Staffing of extra personnel to decrease the patient-to-nurse ratio Only trained personnel may insert CVCs Assistance in central line insertion or trainee supervision

Abbreviations: CLABSI, central line–associated bloodstream infection; CVC, central venous catheter; ICU, intensive care unit; IHI, Institute for Healthcare Improvement.