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Implementation of Supportive Care Program to Decrease CLABSI in a Middle East Pediatric Hematology and Oncology
Kurt Thompson1, Mahdi Shaheen2
1Sidra Medicine, Doha, Qatar.
Insights
Implementing daily bathing, oral care, and ambulation interventions significantly reduced central-line-associated bloodstream infections (CLABSI) in pediatric oncology patients. This initiative demonstrates achievable CLABSI-free care through supportive preventive measures.
Area of Science:
- Pediatric Hematology/Oncology
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- Central venous catheters (CVCs) are vital for pediatric cancer care but increase central-line-associated bloodstream infection (CLABSI) risk.
- Despite existing care bundles, preventing CLABSI in pediatric oncology remains a significant clinical challenge.
- Effective CLABSI prevention strategies are crucial for improving patient outcomes and reducing healthcare-associated infections.
Purpose of the Study:
- To implement and evaluate supportive preventive care interventions to decrease CLABSI rates in pediatric hematology/oncology patients.
- To assess the impact of daily bathing, oral care, and ambulation on CLABSI incidence.
- To identify factors contributing to sustained CLABSI-free periods in a tertiary hospital setting.
Main Methods:
- A mixed-methods approach was used to implement and monitor the 'Step 1-2-3' intervention (daily bathing, twice-daily oral care, thrice-daily ambulation).
- Interventions included targeted patient care protocols and comprehensive parent and staff education.
- Data on CLABSI events were collected and analyzed pre- and post-intervention.
Main Results:
- The pediatric oncology unit achieved 492 CLABSI-free days following the intervention's implementation.
- A temporary increase in CLABSI was observed during a period of high patient acuity and staff shortages.
- Sustained CLABSI-free status was maintained from January 9, 2022, through August 2022.
Conclusions:
- Extended CLABSI-free care periods are achievable in pediatric hematology/oncology units through consistent implementation of supportive preventive measures.
- Continuous data collection and analysis are essential for understanding CLABSI events and refining prevention strategies.
- The 'Step 1-2-3' intervention demonstrates a viable approach to enhancing patient safety and reducing infection rates.
Abstract:
Background: Central venous catheters (CVCs) support the administration of chemotherapy and other medications, blood products, fluids, and nutrient infusions, and reduce the need for peripheral blood sampling in children with cancer. CVC use is also associated with the risk of central-line-associated bloodstream infection (CLABSI). Despite the implementation of CLABSI care bundles, CLABSI prevention remains challenging. Method: This project implemented supportive preventive care interventions to decrease CLABSI in pediatric hematology/oncology patients in a tertiary hospital in the Middle East region. Interventions included bathing or skin care once daily, oral care twice daily, and ambulating patients three times daily. Parent and staff education materials were developed. The project moniker was Step 1-2-3, inspired by successful implementations of such measures in a U.S. cohort showing reduced CLABSI rates. The project used a mixed methods approach. We report outcomes through August 2022. Results: Pre-project (12/2019-05/2020) five CLABSIs occurred in the inpatient unit. Following the implementation of Step 1-2-3, Pediatric Oncology achieved 492 CLABSI-free days. Six CLABSIs then occurred over a short period of time between October 2021 and January 2022, which was associated with high levels of patient acuity and staff sick leave. The inpatient ward remained CLABSI-free from January 9, 2022, through August 2022. Discussion: Extended periods of CLABSI-free care in a pediatric hematology/oncology unit are achievable. A variety of factors contribute to the sustainability of being CLABSI-free. Data collection and analysis are important factors which aided in our understanding of our own CLABSI events.
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