(03) All Smiles for CLABSI Prevention: Improving Oral Care in Inpatient Oncology and Blood and Marrow Transplant

Title: All Smiles for CLABSI Prevention: Improving Oral Care in Inpatient Oncology and Blood and Marrow Transplant

Abstract : Basis of Inquiry
CLABSIs cause increases in morbidity, mortality, length of hospital stays, and healthcare cost (Kemp et al., 2019). A subset of CLABSIs called mucosal barrier injury (MBI)-CLABSIs affect pediatric inpatient oncology and blood and marrow transplant (BMT) patients because of chemotherapeutic treatment regimens and subsequent neutropenia. Maintaining quality oral hygiene is one of the most important interventions for mucositis-related infection prevention (Soga et al., 2011; Linder et al., 2017).

From 2013 to 2024, MBI-CLABSIs accounted for 53% of the total CLABSIs on the Inpatient Oncology and BMT units at the Children’s Hospital of Philadelphia (CHOP). The Inpatient Oncology and BMT team developed a quality improvement (QI) project focusing on a reduction of MBI-CLABSIs, with an overarching goal to prevent all CLABSIs.

Purpose/

Objective:
CHOP’s oral care policy is tooth brushing twice daily. Baseline data (June 1st, 2023-June 30th, 2023) revealed that tooth brushing on the units was documented as completed 8.2% of the time as indicated by the current CHOP policy. The project team utilized CHOP’s Improvement Framework to identify themes of unclear oral hygiene standards of care, inconsistent documentation of oral care completion, and inadequate stock of supplies.

Methods:
The team implemented numerous tests of change based on the themes identified, including implementation of a new oral care bundle.

Findings or Outcomes:
Soon after implementation of the new oral care bundle, tooth brushing compliance experienced a centerline shift up. By June 2024, tooth brushing compliance reached a record high of 27%. There was an overall decrease in CLABSIs and MBI-CLABSIs in FY24 as well as a 154 day stretch without an MBI-CLABSI from January 2024 to June 2024, suggesting continued improvement throughout FY25. The project team plans to continue education and implementation of the bundle to reach a goal of 50% brush compliance by June 30, 2025.