The purpose of this literature review is to determine the contributing factors of CLABSI rate increases during the COVID-19 pandemic and identify interventions which restored CLABSI rates to pre-pandemic levels to guide healthcare professionals’ actions during the next pandemic. Background: In the first two decades of the 21st century, CLABSI rates were reduced in United States hospitals by innovating safer patient care practices. However, there was a significant increase in the annual CLABSI rate in 2020 and 2021, increasing the average length of stay, mortality rate, and cost to the U.S. healthcare system. Methods: An extensive search of CINAHL and MEDLINE databases was conducted using key terms “central line-associated bloodstream infection*”, COVID, and coronavirus. After assessment of eligibility, 16 studies were selected for final review. Results: Contributing factors were staffing issues, deviation from central line care standards, patient diagnosis of COVID-19, supply chain issues, and a lack of interdisciplinary collaboration in central line care. Successful interventions were interdisciplinary involvement, nursing education, CLABSI prevention bundle auditing, a new adaptation of a CLABSI prevention toolkit, and IV access point protector cap usage. Discussion: Although the interventions studied were effective, there was a notable misalignment between some contributing factors and interventions. Staffing issues and supply chain issues were two of the most common contributing factors to CLABSI rate increases, yet there is a lack of research surrounding interventions that may alleviate these factors. Further research must be conducted to address these factors to adequately prepare healthcare professionals for a future pandemic.

Introduction: Central Line-Associated Bloodstream Infections (CLABSIs) are a major cause of increased mortality, morbidity and healthcare costs in neonatal intensive care units (NICUs) patients. Despite CDC's efforts to reduce infection rates, patients often suffer consequences. The objective of this study is to perform a systematic review of strategies utilized in the neonatal population and evaluate them with the current CDC's guidelines to assess the effectiveness of bundles in preventing CLABSI in NICUs. Methods: A systematic literature search was conducted using CINAHL Plus with Text, Cochrane Database of Systematic Reviews and MEDLINE from January 2008 up to 2018. There were multiple search terms used and these included "neonate OR newborn OR infant", "CLABSI OR central line-associated bloodstream infection", "intervention OR prevention" and "bundle". The search solely focused on the outcome of infant patients. Therefore studies were excluded for the following criteria: being non-peer reviewed, being published before 2008, and being a case in which CLABSI was assessed in patients outside the NICU. See Table 4 and 5 for further information. Results: Eight articles were eligible for inclusion all of which CDC's guidelines were implemented in their strategy of intervention. The systematic review showed that adherence to care bundles decreases infection rates drastically. All eight articles reported a significant decrease in CLABSI rates following the implementation of the bundle set by CDC with two studies achieving a CLABSI rate of zero. Author's Conclusion: Implementation of care bundles showed a success in reducing CLABSI rates in the NICUs; however none of the studies endorsed a specific bundle application utilized to achieve its intended goal. Some practices adopted CDC's guidelines more than others and those showed a greater decrease in infection rate. In addition, it is evident that nurses deliver the best care when preventing an infection. Further research is needed to assess the effectiveness of a specific bundle element.