Effects of infection control interventions for preventing catheter-related bloodstream infection in intensive care units: a systematic review and meta-analysis

Central venous catheters are associated with a high risk of catheter-related bloodstream infection (CRBSI). Although multiple preventive strategies have been proposed, their comparative efficacy remains unclear. We aimed to systematically quantify the effects of infection-control interventions for preventing CRBSI in adult intensive care unit (ICU) patients with central venous catheters. This systematic review and meta-analysis follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, Cochrane, and CINAHL were searched for articles published between January 2000 and August 2025. Only randomized controlled trials involving adult ICU patients with central venous catheters were included. The primary outcome for quantitative synthesis was CRBSI, defined as bloodstream infection with evidence supporting catheter-relatedness according to original trial definitions. Secondary analyses were prespecified subgroup analyses of CRBSI according to intervention type and catheter-related technology subtype. Study quality was assessed using the Cochrane Risk of Bias 2.0. Random-effects meta-analysis was used to estimate pooled odds ratios with 95% confidence intervals. Twenty-eight randomized controlled trials assessing CRBSI or CRBSI-compatible bloodstream infection outcomes were included in the systematic review. Interventions included catheter type or connector modifications, dressing materials, skin antisepsis before insertion, antiseptic bathing, and bundle-based catheter-care strategies. Nineteen CRBSI effect sizes were suitable for quantitative meta-analysis. CRBSI was significantly reduced by catheter type interventions (OR = 0.75, 95% CI 0.59–0.94; p < 0.01) and dressing interventions (OR = 0.52, 95% CI 0.28–0.95; p = 0.03). Bathing interventions did not show a significant effect (OR = 0.74, 95% CI 0.38–1.41; p = 0.36). In the catheter technology subgroup analysis, no individual device technology effect was significant, when analyzed separately. This CRBSI-focused synthesis suggests that catheter-type interventions and dressing interventions may reduce CRBSI among adult ICU patients; bathing interventions did not provide a significant reduction. Evidence for individual catheter technologies remains inconclusive. Future trials should apply explicit CRBSI definitions, report extractable event counts and catheter exposure data, describe concurrent bundle practices, and incorporate cost-effectiveness analyses to guide implementation across diverse health care settings. Not applicable. The study protocol was prospectively registered in the Open Science Framework (OSF Registration DOI [ https://doi.org/10.17605/OSF.IO/S49XA ]).