Reducing Central Line‐Associated Bloodstream Infections in ICUs : A Systematic Review of Barriers and Facilitators and Intervention Measures

Background Despite established guidelines, central line‐associated bloodstream infection (CLABSI) remains a severe ICU complication due to cognitive and resource barriers hindering healthcare worker compliance. A systematic evaluation of these barriers and facilitators is currently lacking but is important for informing targeted implementation strategies for CLABSI prevention. Aims To explore the barriers and facilitators to implementing CLABSI prevention in ICUs using the Consolidated Framework for Implementation Research (CFIR) to provide evidence‐based strategies for improvement. Study Design A PRISMA‐guided systematic review was performed using PubMed, Embase, CINAHL, Web of Science, Cochrane Library, CNKI, VIP, Wan fang, and CBM databases, up to August 2026. Eligible studies included qualitative, quantitative, or mixed‐methods research on the barriers and facilitators to CLABSI prevention implementation among ICU healthcare workers. Two researchers independently screened studies, extracted data, and assessed quality using the Mixed Methods Appraisal Tool (MMAT). Data synthesis and intervention development were guided by the CFIR, with targeted strategies mapped using the CFIR‐ERIC (Expert Recommendations for Implementing Change) matching tool. Results The literature search identified 1,780 records, of which 28 studies were ultimately included. The review identified 28 barriers and facilitators, which were synthesized into four major themes and mapped to 16 CFIR constructs across the catheter‐care continuum. The most prominent barriers involved staff knowledge gaps, inconsistent adherence to recommended practices, limited resources, and insufficient leadership support. CFIR‐ERIC mapping identified 11 Level 1 expert‐endorsed implementation strategies, of which four were represented in the included literature and seven were identified as potential implementation gaps. Conclusions CLABSI prevention in ICUs is influenced by multilevel implementation determinants spanning individual, organizational, and practice‐related factors. A structured implementation‐science approach may help healthcare organizations identify context‐specific barriers and prioritize targeted strategies to support more consistent implementation of evidence‐based CLABSI prevention practices. Relevance to Clinical Practice Improving CLABSI prevention may require multilevel strategies that combine targeted education and training, adequate resource allocation, leadership engagement, standardized clinical procedures, and ongoing audit and feedback. These strategies may help strengthen adherence to evidence‐based practices, improve quality of care, and enhance patient safety in ICUs.