Nurse-Led Quality Initiative Reduces CLABSI Risk in Hematologic Cancer Care

A multidisciplinary, nurse-led quality improvement initiative presented at the 50th Annual Oncology Nursing Society (ONS) Congress identified opportunities to strengthen central line-associated bloodstream infection (CLABSI) prevention beyond traditional maintenance bundles in patients with hematologic malignancies.

The study, presented by Melanie Longo, an oncology nurse specialist at Hackensack University Medical Center in Hackensack, New Jersey, focused on improving documentation of chlorhexidine bathing, standardizing antiseptic products across inpatient oncology units and refining blood culture collection practices. The initiative was designed to improve consistency in central line care and reduce infection risk among patients receiving treatment for blood cancers, many of whom require long-term central venous access throughout their care.

In an interview with CURE at the ONS Congress, Longo discussed the rationale behind the initiative, key workflow changes and the critical role bedside nurses played in sustaining practice improvements.

What gaps did your team identify in traditional CLABSI prevention strategies?

According to Longo, the team found that traditional central line maintenance bundles were largely comprehensive, prompting investigators to look beyond standard prevention measures for additional opportunities to reduce infections.

One key issue involved documentation of chlorhexidine bathing. While patients were expected to use chlorhexidine, an antiseptic cleanser that reduces bacterial burden on the skin, there was inconsistent documentation confirming that bathing had occurred.

"There was a gap in documentation to show that the patients were actually doing it," Longo explained. "It's one thing to say that they're doing it, but it's another thing to have it documented that they did it."

The team also identified confusion among staff and patients caused by the availability of multiple chlorhexidine products throughout the hospital. To address this, the group partnered with hospital distribution teams to reduce the number of available products and standardize usage across inpatient oncology units.

Which workflow or documentation changes had the greatest impact on reducing CLABSI rates?

Longo pointed to blood culture collection standardization as one of the most influential interventions.

Beginning in 2023, the institution aligned its practices with nationally recognized central line maintenance guidelines by requiring needleless connector changes before blood culture collection. Because sterile technique is routinely used on the stem cell transplant and cellular therapy unit, incorporating connector changes into the blood culture collection process helped reduce contamination rates and improve specimen quality.

The team also collaborated closely with providers to reduce unnecessary blood culture collection. Previously, blood cultures were often obtained from every lumen of a multi-lumen catheter. The revised approach reduced collections to a single lumen when appropriate.

By decreasing the number of cultures collected, the team reduced the likelihood of contamination that could falsely appear to be a CLABSI event.

Longo also emphasized the value of improved bathing documentation, which allowed staff to monitor compliance and identify opportunities for patient education and reinforcement.

How did standardizing connector changes and blood culture collection improve staff consistency?

Longo said the initiative served as an opportunity to retrain staff and reassess competencies related to central line maintenance and blood culture collection.

When the new process launched, nurses participated in education and competency assessments designed to ensure procedures were being performed consistently. The training helped establish a common standard across shifts and experience levels.

"It was a fresh reset for a lot of our staff," Longo said.

The education process also increased confidence among nurses who may not routinely perform connector changes as part of their daily workflow. Today, those competencies remain incorporated into annual training requirements, helping sustain consistency over time.

What role did bedside nurses play in sustaining these practice changes?

Although the initiative was led by oncology nurse specialists and other nursing leaders, Longo stressed that bedside nurses were central to its success.

"They are the ones that are doing it day in and day out," she said.

Feedback from frontline nurses informed many of the workflow refinements implemented during the project. Their observations helped identify practical challenges, evaluate processes and shape improvements that could be successfully integrated into daily care.

Longo credited bedside nurses with driving the outcomes discussed in the project and helping ensure that practice changes remained sustainable.

Why are patients with hematologic cancers especially vulnerable to central line-associated bloodstream infections?

Patients with hematologic malignancies often require central venous catheters for extended periods to facilitate chemotherapy administration, blood draws and supportive care.

These central lines provide reliable vascular access while reducing the need for repeated needle sticks. However, because the devices terminate in major blood vessels near the heart, they can also become a pathway for infection if pathogens enter the bloodstream.

At the same time, many patients with blood cancers are immunocompromised due to both their disease and treatment, making them particularly susceptible to serious infections.

As a result, preventing CLABSIs remains a critical component of supportive oncology care.

What do reductions in CLABSI rates mean for patient safety and the treatment experience?

Longo emphasized that preventing bloodstream infections can help patients avoid serious complications, including life-threatening outcomes.

Reducing infection risk allows patients to continue cancer treatment with fewer interruptions and helps support better overall outcomes. In addition to the clinical benefits, preventing hospital-acquired infections can reduce healthcare costs and resource utilization.

Ultimately, Longo said, CLABSI prevention is fundamentally about protecting patients.

"We don't want to give anyone an infection that they didn't have or they shouldn't have," she said. "It's patient safety at the end of the day."

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