Identifying health care provider, system, and resource-related factors associated with CLABSIs in ICUs of LMICs: A scoping review

Background Central line-associated bloodstream infections (CLABSIs) in lower-middle income countries (LMICs) are a major cause of morbidity and mortality, particularly in patients admitted to intensive care units (ICUs). Few studies have explored healthcare providers and organizational factors contributing to CLABSIs; however, the literature remains scarce. Methods A scoping review was conducted using the JBI methodology. Four electronic databases (MEDLINE, EMBASE, CINAHL, and SCOPUS) were searched from 2011 to 2024 using predefined eligibility criteria based on the PCC framework. Results Of 897 articles identified, 30 met the inclusion criteria. Studies were predominantly from the Middle East and North Africa (50%, n=15) and South Asia (43%, n=13), with most using quantitative designs (93%, n=28). Three categories of factors associated with CLABSIs were identified: (1) HCP-related factors, including non-compliance with infection prevention practices, knowledge and training deficits, and technical skill gaps; (2) system-related factors, including weak governance, inadequate policy implementation, poor safety culture, and limited learning opportunities; and (3) resource-related factors, including staffing shortages, high workload, equipment and supply constraints, and financial limitations. Conclusions This review identifies a critical gap in LMIC ICUs. Addressing the HCP, system, and resource-related barriers identified in this review is essential for developing effective, context-appropriate infection prevention strategies.