Date of Award

10-10-2025

Degree Type

Thesis

Degree Name

MSc in Nursing

First Advisor

Dr Rubina Barolia

Second Advisor

Dr Muhammad Faisal Khan

Third Advisor

Babar Islam

Department

School of Nursing and Midwifery, Pakistan

Abstract

Background: The intensive care unit carries a high-risk environment for Central Line Associated Bloodstream Infections (CLABSI) due to advanced hemodynamic monitoring, bedside invasive procedures, multiple intravenous lines, prolonged use of devices, and compromised immunity. CLABSIs are one of the most common healthcare-associated infections, resulting in a significant increase in mortality, morbidity, financial burden, overuse of antibiotics, and extended hospital stays.
Purpose: The purpose is to explore the actual compliance rate of CLABSI bundle components through the direct observation method. Second, to identify the contributing factors that lead to non-adherence among ICU nursing staff.
Method: A quantitative cross-sectional analytical design integrating two distinct parts, combining direct observation for CLABSI bundle compliance rates. Part I involved direct observation of 170 CLABSI bundle forms, distributed across three shifts involving 56 eligible ICU nurses at a tertiary care hospital in Karachi, Pakistan. Part II utilized a structured questionnaire to assess perceived factors hindering compliance among ICU nurses.
Study Findings: The bundle's core component reported poor compliance with Hand Hygiene Before Access at just 62.4%, significantly lower during the night shift (49.1%, p=.017). Catheter Hub Disinfection showed moderate compliance at 72.9%. In contrast, elements like dressing integrity, daily chlorhexidine baths, and line necessity reviews showed higher adherence (78.2% to 84.7%). The survey findings (Part II) highlighted key perceived barriers: a high workload (69.2% agreement), the unpredictable nature of emergencies (69.2%), and significant nursing staff shortages (67.3%). Furthermore, the demographic profile exhibits a young, educated, and inexperienced workforce.
Conclusion: A direct observation study confirms poor compliance with the CLABSI bundle in the ICU, especially in key infection control practices such as hand hygiene before and after access and hub disinfection. The findings indicate that non-adherence is less likely due to a knowledge and training gap. Instead, the results highlight factors like workload, staff shortages, systemic pressures, including high stress, and the demanding ICU environment, all of which are exacerbated by an inexperienced workforce.

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