The rate of mucosal barrier injury (MBI) laboratory-confirmed blood stream infections (LCBIs) in patients who experience prolonged neutropenia associated with chemotherapy for hematologic cancers can be reduced through nurse and physician education and implementation of an oral care bundle, according to a study published in JCO Oncology Practice.
The Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) established 2 criteria to differentiate LCBIs from central line-associated bloodstream infections (CLABSIs), which were the identification of an organism with a known relationship to the oral cavity or gastrointestinal tract and MBI-compatible signs or symptoms in patients with either graft-versus-host disease associated with allogeneic stem cell transplantation or neutropenia.
Mucosal barrier injury occurs during periods of prolonged neutropenia in patients receiving cytotoxic chemotherapy for hematologic malignancies. These events can lead to life-threatening LCBIs caused by bacteria crossing compromised intestinal and mucosal barriers. A multidisciplinary team at the University of Virginia Health System (UVAHS) in Charlottesville sought to reduce the number of MBI-LCBI events at their facility.
Using the CDC-NHSN criteria, retrospective reviews of 3 studies found that 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 that the baseline number of events at the tertiary academic medical center was 1.1 per month. The team’s goal was to make a 25% reduction in the number of events per month in patients undergoing inpatient chemotherapy for hematologic malignancies by January 2019.
Root cause analysis revealed that interventions focused on mucositis prevention, assessment, and treatment could potentially reduce MBI-LCBI events. Rates of MBI-LCBIs were tracked for a baseline cohort and across implementation of 3 Plan-Do-Study-Act (PDSA) cycles.
The team identified 93 CLABSI events; the most common diagnoses were acute myeloid leukemia (50%), acute lymphoblastic leukemia (18%), and multiple myeloma (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%) were female. Sixteen organisms were identified as the cause of the infections, with the most commonly identified organisms being Escherichia coli, Klebsiella pneumoniae, and Streptococcus mitis. The types of central lines associated with MBI-LCBI included internal jugular central lines (77), peripherally placed central lines (14), and subclavian placed lines (2).