JOPHON NCPD (July/Aug 2025) Beyond the Bundle: Reducing Central Line Associated Bloodstream Infections on a Pediatric Hematology, Oncology, and Bone Marrow Transplant Unit-JOPHON NCPD (July/Aug 2025) Beyond the Bundle: Reducing Central Lineâ€“Associated Bloodstream InfectionsÂ onÂ a PediatricÂ Hematology, Oncology, and Bone Marrow Transplant Unit

JOPHON NCPD (July/Aug 2025) Beyond the Bundle: Reducing Central Lineâ€“Associated Bloodstream InfectionsÂ onÂ a PediatricÂ Hematology, Oncology, and Bone Marrow Transplant Unit

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Pdf Summary

This quality improvement project addressed persistently high central line–associated bloodstream infection (CLABSI) rates in a pediatric hematology/oncology/bone marrow transplant (PHOB) unit, where standard CLABSI prevention bundle adherence (~95%) was not sufficient to meet goals. The team implemented four additional interventions using Plan-Do-Study-Act cycles: (1) in situ simulation to strengthen bedside nurses’ technical skills and, importantly, critical thinking around unexpected line-related events; after early low-engagement formats, a month-long “BINGO” game combining skills, scenarios, and knowledge questions achieved near-universal participation. (2) Interdisciplinary proactive safety huddles to identify patient-specific risks and mitigation strategies, initially focused on high-risk HSCT admissions and later expanded to other severely neutropenic patients; the huddles evolved into twice-weekly rounds and increasingly included bedside staff and families. (3) Replacement of 70% isopropyl alcohol hub disinfection with Prevantics Device Swabs (70% alcohol + 3.15% chlorhexidine), with workflow adjustments to address stickiness and surface discoloration. (4) Expansion of levofloxacin prophylaxis beyond high-risk leukemia to include HSCT, select high-dose chemotherapy populations, and patients expected to have prolonged severe neutropenia, starting as ANC neared ~200/µL and stopping when recovery was sustained.<br /><br />Over a 30-month period, the unit’s non–mucosal barrier injury (non-MBI) CLABSI rate decreased from a 2021 baseline of 2.19 to 0.52 infections per 1,000 catheter days, surpassing the target of ≤1.0. MBI CLABSI rates did not improve, highlighting the need for different prevention strategies for mucosal translocation-related infections. Proactive huddle data (310 huddles) most often identified hygiene gaps (mouth care, CHG bathing) as key risks. Expanded levofloxacin did not increase hospital-acquired C. difficile infection rates, which remained stable. The authors conclude that PHOB patients may require targeted measures beyond traditional bundles, and these interventions may be transferable to similar programs.

Keywords

CLABSI reduction

pediatric hematology oncology

bone marrow transplant unit

Plan-Do-Study-Act cycles

in situ simulation training

interdisciplinary safety huddles

chlorhexidine alcohol hub disinfection

Prevantics device swabs

levofloxacin prophylaxis

mucosal barrier injury bloodstream infection