Abstract
Topic Significance & Study Purpose/Background/Rationale: Infections continue to be the largest cause of morbidity and mortality in the blood and marrow transplantation (BMT) setting. Immunosuppression from conditioning regimens and delayed immune recovery make the patient vulnerable to both opportunistic infections and healthcare associated infections (HCAIs). Therefore, infection prevention strategies are essential to help minimize their incidence. Working towards reducing HCAIs, the state of New South Wales (NSW) in Australia released a Health Policy Directive (HPD) standardising environmental cleaning across all public health hospitals, including “extreme risk” areas like pediatric BMT units. We utilized the Clinical Excellence Commission (CEC) audit tool as defined in the HPD to ensure defined acceptable quality levels (AQL) were achieved. Based on these guidelines preventative interventions were put in place to aid the reduction of HCAIs in the BMT setting. Methods, Intervention, & Analysis: In 2013, trained personnel commenced inspections of BMT rooms both internally and externally, as per the CEC audit tool. Mandatory audits and their frequency were commenced as defined in the HPD. A time in motion study was also initiated to observe cleaning of BMT rooms in real time. Standard operating procedures were reviewed and practical teaching sessions using simulation training (SIM), were rolled out to cover the step-by-step instructions of cleaning a BMT room to domestic service personnel, including the use of personal protective equipment (PPE). Findings & Interpretation: External auditing demonstrated improvement in the AQL for environmental cleaning from 60% compliance in 2013 to 95% compliance in 2016. By the use of education in the form of SIM training, improvement in the standard of cleaning and disinfection of the BMT rooms was able to be demonstrated. Discussion & Implications: By implementing continued education sessions every 6 months alongside regular auditing, the unit will maintain a high level of environmental cleaning standards to minimize HCAIs in the pediatric BMT patient.
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