The rate of mucosal barrier injury (MBI) laboratory-confirmed bloodstream infections (LCBIs) in patients who experience prolonged neutropeniaassociated with chemotherapy for hematologic cancers can be reduced throughnurse and physician education and implementation of an oral care bundle, accordingto a study published in JCO OncologyPractice.

The Centers for Disease Control and Prevention National HealthcareSafety Network (CDC-NHSN) established 2 criteria to differentiate LCBIs fromcentral line-associated bloodstream infections (CLABSIs), which were theidentification of an organism with a known relationship to the oral cavity or gastrointestinaltract and MBI-compatible signs or symptoms in patients with eithergraft-versus-host disease associated with allogeneic stem cell transplantationor neutropenia.

Mucosal barrier injury occurs during periods of prolonged neutropeniain patients receiving cytotoxic chemotherapy for hematologic malignancies. Theseevents can lead to life-threatening LCBIs caused by bacteria crossing compromisedintestinal and mucosal barriers. A multidisciplinary team at the University ofVirginia Health System (UVAHS) in Charlottesville sought to reduce the numberof MBI-LCBI events at their facility.

Using the CDC-NHSN criteria, retrospective reviews of 3 studies foundthat 71%, 44%, and 45% of CLABSI events met the criteria for MBI-LCBI. Therefore,the UVAHS team performed a single-institution retrospective analysis and found thatthe baseline number of events at the tertiary academic medical center was 1.1per month. The teams goal was to make a 25% reduction in the number of events permonth in patients undergoing inpatient chemotherapy for hematologicmalignancies by January 2019.

Root cause analysis revealed that interventions focused on mucositisprevention, assessment, and treatment could potentially reduce MBI-LCBI events.Rates of MBI-LCBIs were tracked for a baseline cohort and across implementationof 3 Plan-Do-Study-Act (PDSA) cycles.

The team identified 93 CLABSI events; the most common diagnoses wereacute myeloid leukemia (50%), acute lymphoblastic leukemia (18%), and multiplemyeloma (14%). Of the 93 CLABSI events, 53 (57%) met criteria for MBI-LCBI.Patients with MBI-LCBIs were an average of 55 years old and 20 (38%) werefemale. Sixteen organisms were identified as the cause of the infections, withthe most commonly identified organisms being Escherichia coli, Klebsiella pneumoniae, and Streptococcus mitis. The types of central lines associated withMBI-LCBI included internal jugular central lines (77), peripherally placedcentral lines (14), and subclavian placed lines (2).

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Mucosal Barrier Injuries and Bloodstream Infections Associated With Hematologic Cancer Treatments Reduced With Nurse-Driven Protocol - Oncology Nurse...