Abstract
The study revealed that patients with hospital-acquired infections (HAIs) experienced a length of stay (LOS) that increased from 3 days to 30 days (Stewart et al., 2021). Another study shows that a CAUTI case incurs an additional cost of $13,793, while a CLABSI case incurs an additional cost of $48,108 to the care (Forester et al., 2022).
In October 2021, our department received a request to mitigate the surge in CAUTI and CLABSI rates in Q3 2021. We reviewed the literature and designed standardized tools for skill validation. Then, we observed the nursing practice, identified the fallouts, and prepared an education plan. The goal of the Infection Control on Nursing (ICON) initiative is to standardize the nursing practice. In addition to the initial observation, nursing educators continually observed and evaluated nursing practice.
Since the program began in Q4 2021, nurses have followed the standardized practice, and both CAUTI and CLABSI rates have decreased. We ran a regression model against the data collected from Q1 2021 to Q4 2024. For CAUTI, it reflects a 5.5% quarterly decrease. For CLABSI, the coefficient indicates a 4.3% decrease per quarter. The impact of the ICON Initiative continues. As of Q2 2025, the CAUTI-SIR is at 0.28 compared to the surge in Q3 2021 at 1.027, and the CLABSI-SIR is at 0.263 compared to 1.071 in Q3 2021.
The entire ICON initiative has demonstrated the success of the Nursing Practice Sustainability & Outcomes (NPSO) Model, which was developed by us across various initiatives (Fontenot et al., 2022; Hamlin et al., 2023). The model comprises five steps: assessment, standardization, implementation, continuous observation, and evaluation of patient outcomes. Although previous Evidence-Based prevention projects successfully reduced CAUTI and CLABSI, they have not shown sustainability after the intervention (Star et al., 2024; Marzi et al., 2025).
A recent study demonstrates the sustainability outcomes by applying the Magnet Model in a 25-bed surgical unit (Amaro et al., 2025). Using the NPSO model, we achieved the desired clinical outcome of the intervention and demonstrated its sustainability for more than three years across the entire hospital's inpatient units. The NPSO Model has components of the Magnet Model, demonstrating that continuous surveillance and refresher education are key. We are currently exploring technology innovations to assist with human surveillance, as continuous human surveillance is labor-intensive.
Notes
References:
Stewart, C., Robertson, J., Pan, S., Kennedy, L., Haahr, S., Manoukian, H., Mason, K., Kavanagh, K., Graves, S.J., Dancer, S.J., Cook, B., Reilly, J. (2021). Impact of Healthcare-Associated Infections on Length of Stay. Journal of Hospital Infection, 114, 23–31.
Forrester, J. D., Maggio, P. M., & Tennakoon, L. (2022). Cost of health care–associated infections in the United States. Journal of Patient Safety, 18(2), e477-e479.
Fontenot, N. M., Hamlin, S. K., Hooker, S. J., Vazquez, T., & Chen, H. M. (2022). Physical assessment competencies for nurses: A quality improvement initiative. Nursing Forum, 57(4), 710-716.
Hamlin, S. K., Fontenot, N. M., Hooker, S. J., & Chen, H. M. (2023). Systems-based physical assessments: earlier detection of clinical deterioration and reduced mortality. American Journal of Critical Care, 32(5), 329–337.
Marzi, C., Hoover, J., & Coshatt, C. (2025). Reducing Catheter-Associated Urinary Tract Infections in a Neuroscience Intensive Care Unit by Implementing Established Evidence-Based Practices and Incorporating Novel Approaches. American Journal of Infection Control, 53(6), S51-S52.
Star, K. E., Lindsey, K., Reese, S. M., Paulino, L., Hernandez, L. L., Tynes, I., Eiseman, & K., T. J. (2024). Reducing central line-associated bloodstream infection with a dedicated CLABSI prevention registered nurse role. American Journal of Infection Control, 52(6), 659–663.
Amaro, A., Velez, B., Singer, A., Torcivia, P., Dimino, K., & Camiling-Burke, A. (2025). Nurses leading the way: Transforming CLABSI prevention. Nursing Management, 56(9): 32–36.
Sigma Membership
Alpha Gamma Gamma
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Implementation Science, Sustainable Development Goals, Teaching and Learning Strategies, Treatment Outcomes, Hospital-Acquired Infections, Cross Infection
Recommended Citation
Chen, Hsin-Mei; Hamlin, Shannan; Unhelkar, Vaibhav; and Kavraki, Lydia, "The NPSO Model Decreased Hospital-Acquired Infections and Sustained the Clinical Outcomes" (2026). International Nursing Research Congress (INRC). 261.
https://www.sigmarepository.org/inrc/2026/presentations_2026/261
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-31
The NPSO Model Decreased Hospital-Acquired Infections and Sustained the Clinical Outcomes
Toronto, Ontario, Canada
The study revealed that patients with hospital-acquired infections (HAIs) experienced a length of stay (LOS) that increased from 3 days to 30 days (Stewart et al., 2021). Another study shows that a CAUTI case incurs an additional cost of $13,793, while a CLABSI case incurs an additional cost of $48,108 to the care (Forester et al., 2022).
In October 2021, our department received a request to mitigate the surge in CAUTI and CLABSI rates in Q3 2021. We reviewed the literature and designed standardized tools for skill validation. Then, we observed the nursing practice, identified the fallouts, and prepared an education plan. The goal of the Infection Control on Nursing (ICON) initiative is to standardize the nursing practice. In addition to the initial observation, nursing educators continually observed and evaluated nursing practice.
Since the program began in Q4 2021, nurses have followed the standardized practice, and both CAUTI and CLABSI rates have decreased. We ran a regression model against the data collected from Q1 2021 to Q4 2024. For CAUTI, it reflects a 5.5% quarterly decrease. For CLABSI, the coefficient indicates a 4.3% decrease per quarter. The impact of the ICON Initiative continues. As of Q2 2025, the CAUTI-SIR is at 0.28 compared to the surge in Q3 2021 at 1.027, and the CLABSI-SIR is at 0.263 compared to 1.071 in Q3 2021.
The entire ICON initiative has demonstrated the success of the Nursing Practice Sustainability & Outcomes (NPSO) Model, which was developed by us across various initiatives (Fontenot et al., 2022; Hamlin et al., 2023). The model comprises five steps: assessment, standardization, implementation, continuous observation, and evaluation of patient outcomes. Although previous Evidence-Based prevention projects successfully reduced CAUTI and CLABSI, they have not shown sustainability after the intervention (Star et al., 2024; Marzi et al., 2025).
A recent study demonstrates the sustainability outcomes by applying the Magnet Model in a 25-bed surgical unit (Amaro et al., 2025). Using the NPSO model, we achieved the desired clinical outcome of the intervention and demonstrated its sustainability for more than three years across the entire hospital's inpatient units. The NPSO Model has components of the Magnet Model, demonstrating that continuous surveillance and refresher education are key. We are currently exploring technology innovations to assist with human surveillance, as continuous human surveillance is labor-intensive.
Description
A nursing education department in an academic hospital has developed the Nursing Practice Sustainability & Outcomes (NPSO) Model to sustain clinical outcomes after interventions. Taking the recent Infection Control on Nursing (ICON) initiative as an example, ICON suppressed CAUTIs and CLABSIs immediately after the intervention in Q4 2021. Following the intervention, the nurses have continued to adhere to standardized practices, and the infection rates have remained low for over three years.