Abstract Rationale Central line-associated bloodstream infections (CLABSIs) remain among the most consequential healthcare-associated infections in intensive care units (ICUs), driving excess mortality, prolonged hospitalization, and substantial costs. Despite widespread prevention efforts, adherence remains inconsistent, and recent national surveillance shows that ICU specific infection rates have not yet returned to pre pandemic levels, underscoring the need to evaluate contemporary educational and multicomponent strategies. The aim of this study was to systematically synthesize evidence on educational, bundle-based, and multicomponent interventions for CLABSI prevention in adult ICUs, and to examine their effects on care process measures (provider knowledge and adherence), and patient outcomes (CLABSI incidence rates). Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched, with an updated search in April 2025. Eligible studies included empirical research in English conducted in adult ICUs that evaluated educational and/or bundle-based CLABSI prevention interventions. Two reviewers independently screened and extracted data; risk of bias was assessed with Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) and certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results A total of 24 studies were included from 419 screened records, comprising two randomized trials and the remainder pretest-posttest quasi-experimental and quality improvement evaluations. Nearly all studies implemented multicomponent interventions combining education, standardization, policy implementation, auditing, and reminders, with education being the most common element. Educational interventions (lectures, video-assisted teaching, e-learning, or self-instructional modules) consistently improved provider knowledge, with short-term gains often substantial. Compliance with bundle elements improved across most studies, particularly for hand hygiene, though declines in some domains (e.g., glove use, occlusive dressings) were noted. CLABSI incidence rates were reported in 15 studies, of which nearly half documented a statistically significant reduction, and sustainability beyond 6-12 months was inconsistently evaluated. Certainty of evidence was judged to be very low across outcomes due to study design, small samples, and reporting limitations. Conclusions While educational and bundle-based interventions reliably enhance care process measures, consistent reductions in CLABSI rates require organizational scaffolding, including leadership accountability, process standardization, and real-time compliance monitoring. Future trials with adequate power should incorporate implementation science frameworks and pragmatic designs with longer follow-up, comparing traditional and emerging digital modalities to determine whether improved knowledge and adherence translate into patient-level benefit. This abstract is funded by: Agency for Healthcare Research and Quality (AHRQ)
Kim et al. (Fri,) studied this question.