Increasing Activities of Daily Living Is as Easy as 1-2-3

Best, Deanna; Osterkamp, Erin; Demmel, Kathleen Marie; Kiniyalocts, Shivonne; Mock, Shawn; Mulligan, Kelly; Bell, Angela; Doughman, Crystal; Flemming, Miranda; Flesch, Laura; Hawkins, Deanna; Pate, Abigail; Bedel, Ashley; McKenna, Lori Ann; Teusink, Ashley; Jodele, Sonata; Nagarajan, Rajaram; Perentesis, John P.; Davies, Stella M.; Dandoy, Christopher E.

doi:10.1177/1043454215616607

Cited by 14 publications

(15 citation statements)

References 25 publications

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“…The frequency of TA-TMA (and perhaps MBI-LCBI) in high-risk patients could be reduced by use of alternative transplant regimes (eg, reduced use of sirolimus and calcineurin inhibitors) or careful screening for TA-TMA and early institution of complement blockade [23]. In alternative strategies, we are currently studying dietary approaches to improve gut permeability and reduce MBI-LCBIs, including vitamins A and D, use of nondigestible oligosaccharides to maintain bowel microbiome diversity, and human behavior strategies to improve compliance with mouth care, another potential site of translocation [24,25]. …”

Section: Discussionmentioning

confidence: 99%

Healthcare Burden, Risk Factors, and Outcomes of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections after Stem Cell Transplantation

Dandoy

Haslam

Lane

et al. 2016

Biology of Blood and Marrow Transplantation

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Mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs) lead to significant morbidity, mortality, and healthcare resource utilization in hematopoietic stem cell transplant (HSCT) patients. Determination of the healthcare burden of MBI-LCBIs and identification of patients at risk of MBI-LCBIs will allow researchers to identify strategies to reduce MBI-LCBI rates. The objective of our study was to describe the incidence, risk factors, timing, and outcomes of MBI-LCBIs in hematopoietic stem cell transplant patients. We performed a retrospective analysis of 374 patients who underwent HSCT at a large free-standing academic children’s hospital to determine the incidence, risk factors, and outcomes of patients that developed a bloodstream infection (BSI) including MBI-LCBI, central line–associated BSI (CLABSI), or secondary BSI in the first year after HSCT. Outcome measures included nonrelapse mortality (NRM), central venous catheter removal within 7 days of positive culture, shock, admission to the pediatric intensive care unit (PICU) within 48 hours of positive culture, and death within 10 days of positive culture. One hundred seventy BSIs were diagnosed in 100 patients (27%): 80 (47%) MBI-LCBIs, 68 (40%) CLABSIs, and 22 (13%) secondary infections. MBI-LCBIs were diagnosed at a significantly higher rate in allogeneic HSCT patients (18% versus 7%, P = .007). Reduced-intensity conditioning (OR, 1.96; P = .015) and transplant-associated thrombotic microangiopathy (OR, 2.94; P = .0004) were associated with MBI-LCBI. Nearly 50% of all patients with a BSI developed septic shock, 10% died within 10 days of positive culture, and nearly 25% were transferred to the PICU. One-year NRM was significantly increased in patients with 1 (34%) and more than 1 (56%) BSIs in the first year post-HSCT compared with those who did not develop BSIs (14%) (P ≤ .0001). There was increased 1-year NRM in patients with at least 1 MBI-LCBI (OR, 1.94; P = .018) and at least 1 secondary BSI (OR, 2.87; P = .0023) but not CLABSIs (OR, 1.17; P = .68). Our data demonstrate that MBI-LCBIs lead to substantial use of healthcare resources and are associated with significant morbidity and mortality. Reduction in frequency of MBI-LCBI should be a major public health and scientific priority.

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Section: Discussionmentioning

confidence: 99%

Healthcare Burden, Risk Factors, and Outcomes of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections after Stem Cell Transplantation

Dandoy

Haslam

Lane

et al. 2016

Biology of Blood and Marrow Transplantation

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“…The inclusion of SPBC is relevant since these can be real BSI in immunocompromised patients . Although there has been progress in the reduction of CLABSI rates using quality improvement methodologies across pediatric centers, the majority of data describing outcomes after BSI in these high‐risk populations is limited to single‐center reviews.…”

Section: Introductionmentioning

confidence: 99%

Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients

Dandoy

Kelley

Gaur

et al. 2019

Pediatric Blood & Cancer

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Background Pediatric hematology/oncology (PHO) patients receiving therapy or undergoing hematopoietic stem cell transplantation (HSCT) often require a central line and are at risk for bloodstream infections (BSI). There are limited data describing outcomes of BSI in PHO and HSCT patients. Methods This is a multicenter (n = 17) retrospective analysis of outcomes of patients who developed a BSI. Centers involved participated in a quality improvement collaborative referred to as the Childhood Cancer and Blood Disorder Network within the Children's Hospital Association. The main outcome measures were all‐cause mortality at 3, 10, and 30 days after positive culture date; transfer to the intensive care unit (ICU) within 48 hours of positive culture; and central line removal within seven days of the positive blood culture. Results Nine hundred fifty‐seven BSI were included in the analysis. Three hundred fifty‐four BSI (37%) were associated with at least one adverse outcome. All‐cause mortality was 1% (n = 9), 3% (n = 26), and 6% (n = 57) at 3, 10, and 30 days after BSI, respectively. In the 165 BSI (17%) associated with admission to the ICU, the median ICU stay was four days (IQR 2‐10). Twenty‐one percent of all infections (n = 203) were associated with central line removal within seven days of positive blood culture. Conclusions BSI in PHO and HSCT patients are associated with adverse outcomes. These data will assist in defining the impact of BSI in this population and demonstrate the need for quality improvement and research efforts to decrease them.

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“…The token economy intervention provided the clinical team with a clear and standardized process by which fundamental positive reinforcement was provided to patients increasing ADL adherence as well as promoting patient activation, self‐management, and family engagement . Medical teams have previously relied on nurse or provider specific interventions including persistent encouragement and reminding when refusing to complete ADL, increasing the likelihood of patient‐provider conflict and undermining patient autonomy …”

Section: Discussionmentioning

confidence: 99%

“…The division performs approximately 100 HSCT procedures each year. All patients are prescribed three ADL (“ADL 1‐2‐3”) including daily bathing with chlorhexidine gluconate (CHG), physical activity twice per day, and an oral hygiene regimen three times per day as previously described . Our current standard of care to ensure adherence to ADL includes routine education regarding the importance of ADL, reporting ADL during rounds between the nursing and physician team, and discussing nonadherence with patients and providers.…”

Section: Methodsmentioning

confidence: 99%

“…Recent studies indicate that the risk for BSIs, oral complications, and deconditioning can be reduced by participation in key activities of daily living (ADL), including daily bathing, physical activity, and oral hygiene. Despite this, many patients fail to perform these important ADL during their inpatient stay at a time they are most vulnerable . There is a critical need to develop robust and sustainable mechanisms to improve ADL adherence, which will prevent BSI, oral complications, and challenges related to inactivity in high‐risk immune‐compromised pediatric oncology/HSCT patients.…”

Section: Introductionmentioning

confidence: 99%

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Token economy to improve adherence to activities of daily living

Hickey

Flesch

Lane

et al. 2018

Pediatric Blood & Cancer

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Increasing Activities of Daily Living Is as Easy as 1-2-3

Abstract: Oral care algorithm and order set, daily text message reminders, and physician intervention with noncompliant and high-risk patients has improved our compliance. Units where compliance with ADL participation is low can benefit from incorporating elements from this ADL 1-2-3 initiative.

Cited by 14 publications

References 25 publications

Healthcare Burden, Risk Factors, and Outcomes of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections after Stem Cell Transplantation

Healthcare Burden, Risk Factors, and Outcomes of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections after Stem Cell Transplantation

Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients

Token economy to improve adherence to activities of daily living

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