#68: Outcomes of Establishing Infection Care and Prevention Standards in Pediatric Oncology Units in Three Hospitals on the Island of Hispaniola

Background Survival of children with cancer goes hand-on-hand with cancer treatment and improvement of infection care and prevention (ICP). The Hispaniola Island project aims to improve the quality of care and survival for children with cancer in 3 pediatric cancer units by implementing ICP programs in these units with the long-term plan of absorbing such programs into the structure of the hospital care delivery process. We report the 1-year outcomes of establishing ICP standards in pediatric oncology units. Methods We followed the general steps for health promotion when engaging with the new sites, which are: (1) planning the process; (2) conducting a situational assessment; (3) identifying objectives; (4) identifying strategies; (5) developing indicators; and (6) tracking progress. Results The planning process included discussions with local leadership, timeline plans for ICP interventions, data gathering, and decision-making. Three healthcare providers were identified and trained through the St. Jude Global educational programs as local ICP champions and institutional contacts. Through site visits and focus group discussions, each unit developed a team consisting of the local ICP champion and an infection preventionist to lead the local unit ICP improvement. Situational analysis revealed no surveillance in infections, suboptimal practices hand hygiene, central-line management, and mechanical ventilation. To guide improvement, the local ICP team begun collecting surveillance of ICP indicators, such as infection rates, with monthly reporting to and mentoring by the St. Jude team. Since February 2019, the 3 sites ICP teams prospectively captured 17,532 patient-days (median: 365 patient-days per month; range: 209–573), 384 central-line days (median: 15 central-line days per month; range: 0–33), identified 278 healthcare-associated infections in 159 patients; monitored hand hygiene through direct (observations) and indirect (alcohol gel consumption) methodologies and provided monthly education sessions in ICP to hospital staff, patients and their families. Early results demonstrate the utility of a dedicated ICP team using a standardized ICP reporting system to guide focused improvement of care delivery. Conclusions Improving ICP standards is essential for any intervention which aims to improve the survival of children with cancer. A step-wise procedure in building local teams, engaging hospital leaders, evaluating on-site resources, and introducing methods to collect infection rates and other quality indicators for healthcare delivery will provide evidence-based guidance to improve the safety of cancer care delivery. We hope that the improvement could be sustained in the longer run by incorporating the created structure and processes to the hospital system.