Kandice Bledsaw PhD, RN (is Director, Quality Outcomes and Analytics, Texas Children's Hospital, Houston.), Zachary D. Prudowsky MD, FAAP (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine, Houston.), Mark C. Zobeck MD, MPH (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Jenell Robins BSDH, RDH (is Oral Health Educator/Registered Dental Hygienist, Texas Children's Hospital.), Sharon Staton MS-SSEM, BSN, RN (is Clinical Specialist, Texas Children's Hospital.), Janet DeJean MSN, RN (is Clinical Specialist, Texas Children's Hospital.), Esther Yang DDS (is Chief of Service, Department of Dentistry, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Claudia X. Harriehausen DDS, MSD (is Pediatric Dentist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Judith R. Campbell MD (is Attending Physician, Texas Children's Hospital, and Professor, Department of Pediatrics, Baylor College of Medicine.), Andrea L. Davis MPH, CIC (is Infection Control Preventionist, Texas Children's Hospital.), Anil George MD (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), David Steffin MD (is Associate Chief, Cell Therapy and Bone Marrow Transplant Program, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Gabriella Llaurador MD (is Pediatric Stem Cell and Transplant Therapy Physician, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Alexandra M. Stevens MD, PhD (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine. Please address correspondence to Zachary Prudowsky)
{"title":"Implementing an Oral Health Educator Contributes to Reduced MBI-CLABSI Rates for Pediatric Hematopoietic Stem Cell Transplant Patients","authors":"Kandice Bledsaw PhD, RN (is Director, Quality Outcomes and Analytics, Texas Children's Hospital, Houston.), Zachary D. Prudowsky MD, FAAP (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine, Houston.), Mark C. Zobeck MD, MPH (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Jenell Robins BSDH, RDH (is Oral Health Educator/Registered Dental Hygienist, Texas Children's Hospital.), Sharon Staton MS-SSEM, BSN, RN (is Clinical Specialist, Texas Children's Hospital.), Janet DeJean MSN, RN (is Clinical Specialist, Texas Children's Hospital.), Esther Yang DDS (is Chief of Service, Department of Dentistry, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Claudia X. Harriehausen DDS, MSD (is Pediatric Dentist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Judith R. Campbell MD (is Attending Physician, Texas Children's Hospital, and Professor, Department of Pediatrics, Baylor College of Medicine.), Andrea L. Davis MPH, CIC (is Infection Control Preventionist, Texas Children's Hospital.), Anil George MD (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), David Steffin MD (is Associate Chief, Cell Therapy and Bone Marrow Transplant Program, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Gabriella Llaurador MD (is Pediatric Stem Cell and Transplant Therapy Physician, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine.), Alexandra M. Stevens MD, PhD (is Pediatric Hematologist/Oncologist, Texas Children's Hospital, and Assistant Professor, Department of Pediatrics, Baylor College of Medicine. Please address correspondence to Zachary Prudowsky)","doi":"10.1016/j.jcjq.2024.07.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Mucosal barrier injury central line–associated bloodstream infections (MBI-CLABSIs) remain a challenge among the pediatric cancer population. These infections commonly occur by oral or gastrointestinal (GI) bacteria translocating through impaired gut or oral mucosa. Although strategies to prevent gut MBI-CLABSIs are well characterized, oral pathogen prevention strategies are lacking.</div></div><div><h3>Methods</h3><div>The authors’ oncodental collaboration quality improvement project, which included two Plan-Do-Study-Act (PDSA) cycles, aimed to improve MBI-CLABSI rates and oral care adherence on a pediatric hematopoietic stem cell transplant (HSCT) unit. PDSA cycle 1 integrated dental residents into existing rounds every third week to screen for dental, gum, and mucosal disease and provide targeted education to patients and families. PDSA cycle 2 implemented a novel oral health educator (OHE) role in which a trained dental hygienist rounded four days per week. Monthly MBI-CLABSI rates and oral care adherence were followed from December 2020 to May 2021 (baseline), June 2021 to March 2022 (PDSA cycle 1), and April 2022 to December 2022 (PDSA cycle 2). Qualitative surveys captured patient and family perception, and a cost savings analysis was completed.</div></div><div><h3>Results</h3><div>A 58.8% reduction in MBI-CLABSI rate (events per 1,000 central venous line days) was detected (baseline: 5.1; PDSA cycle 2: 2.1), oral care adherence improved 41.7% (baseline: 60.9%; PDSA cycle 2: 86.3%), 100% of patients found it beneficial to receive oral care demonstrations, and an annual cost savings of $541,000 was estimated.</div></div><div><h3>Conclusion</h3><div>Direct patient outcomes have measurably improved. This project suggests the implementation of an OHE in pediatric HSCT inpatient units may be valuable to patients and families and may be a cost-effective way to reduce MBI-CLABSIs resulting from oral pathogens.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725024002253","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Mucosal barrier injury central line–associated bloodstream infections (MBI-CLABSIs) remain a challenge among the pediatric cancer population. These infections commonly occur by oral or gastrointestinal (GI) bacteria translocating through impaired gut or oral mucosa. Although strategies to prevent gut MBI-CLABSIs are well characterized, oral pathogen prevention strategies are lacking.
Methods
The authors’ oncodental collaboration quality improvement project, which included two Plan-Do-Study-Act (PDSA) cycles, aimed to improve MBI-CLABSI rates and oral care adherence on a pediatric hematopoietic stem cell transplant (HSCT) unit. PDSA cycle 1 integrated dental residents into existing rounds every third week to screen for dental, gum, and mucosal disease and provide targeted education to patients and families. PDSA cycle 2 implemented a novel oral health educator (OHE) role in which a trained dental hygienist rounded four days per week. Monthly MBI-CLABSI rates and oral care adherence were followed from December 2020 to May 2021 (baseline), June 2021 to March 2022 (PDSA cycle 1), and April 2022 to December 2022 (PDSA cycle 2). Qualitative surveys captured patient and family perception, and a cost savings analysis was completed.
Results
A 58.8% reduction in MBI-CLABSI rate (events per 1,000 central venous line days) was detected (baseline: 5.1; PDSA cycle 2: 2.1), oral care adherence improved 41.7% (baseline: 60.9%; PDSA cycle 2: 86.3%), 100% of patients found it beneficial to receive oral care demonstrations, and an annual cost savings of $541,000 was estimated.
Conclusion
Direct patient outcomes have measurably improved. This project suggests the implementation of an OHE in pediatric HSCT inpatient units may be valuable to patients and families and may be a cost-effective way to reduce MBI-CLABSIs resulting from oral pathogens.
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