Back to Basics: CLABSI Reduction Through Implementation of an Oral Care and Hygiene Bundle

Abstract

Children with cancer often undergo treatments that render them severely immunocompromised. Side effects of treatment place them at risk for developing oral mucositis (OM), which can potentially lead to infection and bacteremia. Staff nurses on an inpatient pediatric oncology unit noted inconsistent daily oral hygiene practices despite assessing OM consistently. Basic oral hygiene can reduce the severity of OM, and evidence-based bundled care has shown to increase consistency of practice. Based on findings and recommendations from the literature, an oral care and hygiene bundle was developed. The oral care bundle included a soft bristled toothbrush, fluoride toothpaste, twice-daily brushing and sodium bicarbonate rinses, lip balm, and oral moisturizer. The hygiene component consisted of a daily bath or shower and daily linen changes. Education on the rationale and purpose for the use of an oral care and hygiene bundle was provided to the inpatient direct care staff prior to implementation on two inpatient oncology units. Audits were performed to measure the adherence of the oral care and hygiene bundle. Central line–associated bloodstream infections were measured in collaboration with the quality and infection prevention departments. Since the oral care and hygiene bundle was implemented, laboratory-confirmed bloodstream infection rates decreased from 1.05 to 0.54 per 1,000 catheter days, while mucosal barrier injury rates decreased from 2.98 to 1.27 per 1,000 catheter days.

Implementation of Supportive Care Program to Decrease CLABSI in a Middle East Pediatric Hematology and Oncology Inpatient Unit

“…This inexpensive and nonirritating solution seems our best option. Kemp et al (2019) identified nurse-to-patient ratios as a contributing factor to adherence to following CVC care and hygiene recommendations. Our spike in CLABSI events occurred during a period of high sick leave utilization among hematology/oncology staff and the need to use rotational staff support from other services within the hospital.…”

Exploring Care Left Undone in Pediatric Nursing

“…Many studies have shown how comfort/talk with patient and educating patients and families are instrumental in various settings (from pediatric intensive care to pediatric hematology-oncology) 31,32 . In addition, performing oral hygiene reduces the risk of central line–associated bloodstream infection and should be provided throughout the patient’s hospital stay 13 . Also preparing patients and families for discharge is important throughout hospitalization, because there is evidence that the presence of a nurse discharge specialist enables to reduce the number of activities to be carried out, thus facilitating the transition from hospital to home 33 …”

“…Unlike some previous studies, 7,24,36 our study provides a focus on single activities and a starting point for a more effective management of this phenomenon. This is essential from an organizational and managerial perspective because it enables nursing leaders to act on the weaknesses of their units and address the activities that have the most negative effects on patient outcomes 2,4,5,11–13,25,38 …”

“…For instance, the omission of patient surveillance is a mediator between low nurse staffing levels and increased mortality 11 . Omission of health care treatment, procedures, and planning expose patients to higher risks of readmission within 30 days, 4,12 and omission of oral hygiene increases the risk of developing central line–associated bloodstream infection 13 . Finally, omission of pain management reduces patients recommending the hospital to others 6 …”

Prospective Initiative to Reduce Mucosal Barrier Injuries and Bloodstream Infections in Patients With Hematologic Malignancy Receiving Inpatient Chemotherapy

“…Vaughan et al 11 retrospectively examined their CLABSI events to determine whether standard bundle protocols for central line care would reduce MBI-LCBI events and found a reduction in both MBI-and non-MBI-related events. Furthermore, Kemp et al 12 recently published their attempts to reduce CLABSI events through oral care and hygiene. Through the implementation of an oral care bundle alone, they were able to demonstrate a significant reduction in both MBI and LCBI events.…”