Pediatric Bone Marrow Transplant Unit Research Articles

The Phenotype of a Bone Marrow Transplant Nurse: Survival of the Fittest

There is a need for proficient nursing practice in specialized critical care settings, such as a pediatric Bone Marrow Transplant (BMT) Unit. The staffing crisis continues to be problematic for areas around the country. Nursing tenure has been positively correlated with improving patient outcomes and confidence in giving care, so efforts must be made to retain pediatric BMT nurses. The purpose of this study was to investigate factors of resilience and how it pertains to the retention of pediatric BMT nurses through 1) Understanding current BMT nursing turnover and trend why nurses are leaving; 2) Measure resilience throughout BMT nursing cohort, covering all tenure of nurses; and 3) Interview senior nurses within the cohort to identify themes relating to retention and resilience using grounded theory methodology. This research was carried out in the Bone Marrow Transplant (BMT) Unit at Cincinnati Children's Hospital Medical Center (CCHMC). The study spanned from 2014 to 2019, during which researchers gathered extensive data to evaluate the turnover risk among BMT nurses. A detailed follow-up was conducted in 2019 to further assess this risk. To measure resilience levels, a group of 115 nurses in the unit completed the Connor Davidson Resilience Scale (CD-RISC). Additionally, in-depth interviews were conducted with nine senior nurses in the cohort, continuing until theoretical saturation was reached, ensuring a comprehensive understanding of the factors influencing nurse turnover in the unit. Researchers looked retrospectively at nursing turnover from 2014-2019. Investigators determined the risk of new nurses leaving was between 22 and 24 months (HR 0.025). Further, follow-up was conducted for data points between 2019-present time, which showed a drastic change in the hazard rate curvature. However, the risk remained relatively the same at 22-24 months (HR 0.03). There was no statistical significance found between CD-RISC results and age (p=0.465), gender (p=0.725), working experience (p=0.15), or education (p=0.14). Through a constant comparative process, several themes were identified as positive, negative, and ambiguous contributions to the retention of nurses. The risk of nurses leaving after two years decreases significantly; therefore, we determined that a nurse with a commitment to pediatric BMT occurs with two years' experience. Although our initial hypothesis was that senior nurses had greater resilience than less tenured nurses, there was no statistical significance as the effect of resilience is small. However, we identified several additional factors pertinent to the pediatric BMT field which may be associated with nursing retention.

5613274 “A PICTURE IS OFTEN WORTH MORE THAN MANY WORDS: STREET ART AS EMPOWERMENT FOR SICKLE CELL DISEASE PATIENTS” JACKELINE ELIZABETH MARAN1, MARINA PERDIBON1, ILARIA BAIDO1, MICHEL NKONGNE GYSLENE2,FABRIZIO CANONICI2, VANIA MUNARETTO3-4, GIULIA REGGIANI3-4, LAURA SAINATI4, ALESSANDRA BIFFI3-4, RAFFAELLA C

Background: Sickle Cell Disease is a genetic and chronic disease which carries a great burden of recurrent symptoms, acute and chronic complications and stigma therefore greatly impacting quality of life and self-perception. Teenagers and young adults often do not want to talk about their disease or do not know how to communicate their experience to others. “Blood Artists”, was a multistakeholder campaign conducted in Italy (a collaboration between Universities, Hospitals, Pharmaceutical Companies, Patients’ Organizations) to raise awareness on Sickle Cell Disease and Thalassemia. Aims: Its main objective was to make people understand, through the direct language of street art, what it means to live Sickle Cell Disease or Thalassemia, two hereditary blood disorders that afflict thousands of people in Italy. The goal was to raise awareness among the public, especially young people, to make them understand how the disease impacts life and that some simple gestures, like blood donation, can help treatment. The street art initiative involved several italian cities including Padua. Methods: Several meeting with representatives of the Sickle Cell Disease Association (Associazione Malattia Drepanocitica) and the artis were organized to communicate the patients’ experience in living with SCD. Following the testimony of each patient, a draft of the painting was produced and then shared with the patients who commented and added their further contribution. Results: The Artist SteReal donated a wall painting- Street Art painting-, on the wall facing a very busy street of the Pediatric Hematology Oncology and Bone Marrow Transplant Unit of the Azienda-Hospital University of Padua, Veneto Region Reference Center for the Diagnosis, Care and Treatment of SCD in Childhood and ERN-EuroBloodNet Center of Expertiese. In the Street Art (Figure 1) the 3 individuals with SCD expressed what they thought were the most significant and common aspects of SCD: 1)The mural depicts the image of a mother and daughter playing together, and symbolizes’ the genetic transmission of the disease but also the importance of the family bonds in the patients’ lives and in disease coping; 2) the lightning which arrives suddenly and symbolizes the vaso-occlusive crisis pain symptom that disrupt everyday life; 3) the petals of the daisy that, flying in the wind take the Sickle shape of red blood cells, to represent the disease from a clinical and scientific point of view, but also the renaissance of life that can flourish in spite of the disease. Conclusions: In conclusion, the Street Art initiative represents an important means of making the public aware of people’s experience with their disease and the same time encourages patients to talk about it freely without being ashamed or afraid. The wall painting was used in several meeting with patients as a starting point for sharing experiences and discussion.Figure 1:: The Street Art created through the collaboration between the Artis SteReal and the Associazione Malattia Drepanocitica (Sickle Cell Disease Association), in Padova, Italy on the wall of the Pediatric Hematology Oncology and Bone Marrow Transplant Unit in March 2022.

5613386 CELEBRATING THE SICKLE CELL DISEASE WORLD DAY ON JUNE 19TH AFTER TWO YEARS OF PANDEMIC: MY LIFE WITH SCD, PATIENTS’ PERSPECTIVE

Jackeline Elizabeth Maran1, Marina Perdibon1, Ilaria Baido1, Michel Nkongne Gyslene2, Fabrizio Canonici2, Vania Munaretto3-4, Giulia Reggiani3-4, Alessandra Biffi3-4, Laura Sainati4, Raffaella Colombatti3-4 1Fondazione Città della Speranza Onlus 2Associazione Malattia Drepanocitica 3Dipartimento della Salute della Donna e del Bambino, Università degli Studi di Padova Background: After two years of COVID in which activities were reduced due to the pandemic and each one’s life was affected by restrictions and limitations, the Sickle Cell Disease (SCD) Association in Padova teamed up with the Sickle Cell Group at the Pediatric Hematology Oncology and Bone Marrow Transplant Unit to celebrate the Sickle Cell Disease world day by organizing an online meeting with children/youths and their families. Theme of the meeting was: “My Life with SCD: poems, pictures and writings express our view on disease and care”. Aims: One of the goals of this meeting was to create an opportunity for individuals with SCD to meet and have a constructive discussion with each other about the disease and express their feelings after two years of pandemic. Methods: One month before the meeting children, teenager and parents were asked to sharer with the organizing team any drawing, painting, poem, writing, that they felt could express their feelings or experience of the disease itself or how it affected their life, or their experience in the hospital. The materials received were organized in a power point presentation and At the meeting, families were able to see a PowerPoint presentation with the poems, drawings, writings. Each author had the choice to personally share their production or have it read out loud by a member of the team. Free time to comment or share experiences was given. Results: 20 children, teenagers and parents participated. Countries of origin (Nigeria, Ghana, Congo, Albania, Italy), religious background (catholic, muslim, no religion, other) were different as well as disease genotype (HbSS, HbSC, HbSB°), severity or treatment received (Hydroxyurea, transfusion, Hematopoietic stem cell transplantation -HSCT, none). Drawings and writings regarded experience with the disease (mechanism of action, admissions), feelings experienced (fear, hope, light at the end of the tunnel), aspirations (sports) and gratitude (to the social and medical team, to parents) (Figure 1). Surprisingly, families who had a child having undergone HSCT, reported on the need and importance to talk about this experience for years after the event and made a request of a support goup. Finally, all families underlined the need to meet again soon to discuss together issues related to personal experience with SCD, even via web. of discussion with each other and with the drepanocytosis group; and that throug the online telematics platform it is still possible to involve all families, listening and trying to comfort them on doubts and perplexities about the disease, In conclusion, it can be said that after two years of pandemic, in our setting, online meeting can help patients and families reconnect with each other and activities can be planned to aid experiences and feelings. Patients’ associations and Health Care Teams can collaborate in this area.Figure 1:: Poems and drawings on “My Life with Sickle Cell Disease” by children, teenagers and parents from the Associazione Malattia Drepanocitica

Decreasing Skin Breakdown Around Central Lines in Patients Receiving Thiotepa Prior to Bone Marrow Transplantation.

Skin breakdown occurring around central line dressings increases the risk for infection and bacteremia in all patients. The risk is magnified when experienced in pediatric patients receiving marrow-ablative therapy. A staff nurse on an inpatient pediatric oncology and bone marrow transplant unit noted an increased incidence of skin breakdown around central line dressings in patients receiving Thiotepa prior to bone marrow transplantation. Although there is a wealth of information surrounding routine care of central venous access devices, there is little evidence surrounding care with impaired skin integrity. A staff nurse turned to expert opinion and consensus revealed the use of nonocclusive dressings for central lines. A new protocol for changing central line dressings was developed to decrease the rate of skin breakdown. The protocol utilized gauze and a self-adherent wrap instead of tape to secure central lines. Bone marrow transplant staff nurses were educated prior to the practice change, and compliance was monitored through observation and review of documentation in the electronic medical record. A retrospective chart review compared the rate of skin breakdown and central line associated blood stream infections pre- and postpractice change. The overall percentage of skin breakdown surrounding central lines was reduced by over 80%.

Hematopoietic Stem Cell Transplantation in Patients with Severe Combined Immunodeficiency: A Single-Center Experience

Objective: The aim of this study was to determine the factors affecting outcomes in patients who underwent hematopoietic stem cell transplantation (HSCT) with the diagnosis of severe combined immunodeficiency (SCID). Furthermore, our aim is to share our singlecenter experience of HSCT among SCID patients. Materials and Methods: The data of patients who underwent HSCT with the diagnosis of SCID between January 2014 and January 2021 in the pediatric bone marrow transplant unit of Istanbul Medipol University were retrospectively analyzed. Demographic and clinical data, treatment regimens, donor source, type of transplantation, pre- and post-transplantation infections, and complications were evaluated. Results: Among fifteen patients who underwent HSCT, 5 (33%) were female. The mean age at diagnosis was 3 months (1-6 months), and at transplantation 6 months (3-10 months). The mean time from diagnosis to transplantation was 3 months (2-9 months). There was a history of consanguineous marriage in thirteen (87%) and sibling death in eight (53%) cases. As donors, six (40%) were siblings and five (33%) were unrelated, while four (27%) patients underwent haploid transplantation. Four (27%) patients died during the first 100 days of transplantation. The median follow-up period was 23 months (9-61 months). Overall survival probability was calculated as 73%. Conclusion: SCID should be considered as an emergency in pediatrics. Devastating complications, including severe organ damage, lifethreatening infections, and even death, could appear in case of diagnostic delay. HSCT is a currently available curative treatment option. Subjects with a confirmed diagnosis should be referred to the appropriate bone marrow transplant center and treated as soon as possible.

A national study of antibiotic use in Greek pediatric hematology oncology and bone marrow transplant units.

We surveyed antimicrobials used in Greek pediatric hematology-oncology (PHO) and bone marrow transplant (BMT) units before and after an intervention involving education regarding the 2017 clinical practice guidelines (CPG) for the management of febrile neutropenia in children with cancer and hematopoietic stem-cell transplant recipients. Antibiotic prescribing practices were prospectively recorded between June 2016 and November 2017. In December 2017, baseline data feedback was provided, and CPG education was provided. Prescribing practices were followed for one more year. For antibiotic stewardship, days of therapy, and length of therapy were calculated. Five of the 6 PHO units in Greece and the single pediatric BMT unit participated. Admitted children in each unit who received the first 15 new antibiotic courses each month. Administration of ≥4 antibiotics simultaneously and administration of antibiotics with overlapping activity for ≥2 days were significantly more common in PHO units in general hospitals compared to children's hospitals. Use of at least 1 antifungal was recorded in ∼47% of the patients before and after the intervention. De-escalation and/or discontinuation of antibiotics on day 6 of initial treatment increased significantly from 43% to 53.5% (P = .032). Although the number of patients requiring intensive care support for sepsis did not change, a significant drop was noted in all-cause mortality (P = .008). We recorded the antibiotic prescribing practices in Greek PHO and BMT units, we achieved improved prescribing with a simple intervention, and we identified areas in need of improvement.

Results of a Stepped-Wedge Cluster-Randomized Implementation Science Trial to Improve Chlorhexidine Gluconate Bathing Compliance

Background: Daily chlorhexidine gluconate (CHG) bathing in intensive care units (ICUs) is widely supported in the literature to decrease risk of central-line-associated infections (CLABSIs). However, adoption of this practice is inconsistent. The primary objective of this implementation science study was to assess the effect of a bathing intervention on compliance with the AHRQ CHG bathing protocol. Secondary objectives were to examine (1) moderating effects of unit characteristics, (2) the intervention effect on nursing staff’s knowledge and perceptions of CHG bathing, and (3) the intervention effect on CLABSI rates. Methods: A stepped-wedge cluster-randomized design was used to implement and evaluate the effectiveness of a CHG bathing intervention. At 2 large hospitals, 14 units were clustered into 4 sequences. Units included 9 adult ICUs, 3 pediatric ICUs, 1 pediatric bone marrow transplant unit, and 1 adult hematology-oncology unit. Sequences were enrolled into the active intervention phase over the course of 4 months. The intervention included 2 evidence-based implementation strategies: (1) educational outreach visits and (2) audit and feedback on CHG bathing compliance. Compliance with the CHG bathing processes and daily CHG bathing documentation were assessed. At 12 months after the last enrolled date, booster sessions were completed, and outcomes were assessed for sustainability. Results: In models of CHG bathing process compliance, the implementation strategy was significant (b = 6.97; P = .009), indicating that compliance was 6.97% higher after the intervention than before. There was a statistically significant improvement in nursing knowledge of CHG bathing (χ2 = 9.32, p = .002) and perception of the priority of CHG bathing (t = 2.56; P = .01). Daily CHG bathing documentation compliance and CLABSI rates did not significantly improve immediately following the intervention; however, a clinically significant decrease (27.4%) in CLABSI rate was observed. At 12 months after the intervention, improvements in CHG bathing documentation and process outcomes were sustained. There was no change in bathing process compliance after 12 months (b = −0.19; P = .87; intercept=96.96, p < .001), and compliance remained high at 96.96%. There was no change in documentation compliance after 12 months (b=3.89, p=.37, intercept=78.72, p < .001), and compliance remained high at 78.72%. After 12 months, CLABSI rates were statistically significantly reduced (b = −0.16; P = .009; intercept =1.97, p < .001). Conclusions: Using educational outreach visits and audit-and-feedback strategies can improve the adoption of evidence-based CHG bathing practices. CHG bathing—a simple, nurse-driven practice—can make a significant improvement in patient outcomes.Funding: NoDisclosures: None

Ophthalmologic findings and complications before and after hematopoietic stem cell transplantation: single-center study.

Different and various system complications and late effects may occur after hematopoietic stem cell transplantation (HSCT). It was aimed to obtain information about the frequency of ophthalmologic complications and their relationship with treatment. This retrospective study includes 104 children who underwent HSCT between February 2019 and June 2020 at the Pediatric Bone Marrow Transplant Unit. Patients' ages, genders, diagnosis, transplant types, chemotherapy regimens, transplantation details, conditioning regimens, supportive cares, graft versus host disease (GvHD) prophylaxis, infection episodes, and ophthalmologic findings were evaluated. Of the 104 patients included in the study, 38 (36.5%) were female and 66 (63.5%) were male. Average age ± SD was 8.7 ± 4.91. Considering the diagnoses, the majority of the patients were acute lymphoblastic leukemia (46 patients-44%). Myeloablative regimen was used in 93 (89%) of the patients, and reduced intensity conditioning (RIC) was used in 11 patients (10%). While total body irradiation was applied in 16 (15%) patients, one patient was received cranial radiotherapy. Cyclosporine was used in 96 (92%) patients. CMV reactivation was detected in 54 (51%) of the patients. CMV retinitis was not seen. Ocular pathology was detected in 20 (19%) patients before HSCT and in 12 (11%) patients after HSCT. The most common pathology was dry eye. Routine ophthalmologic examinations are important in terms of early diagnosis. In addition, GvHD and CMV prophylaxis is important because of reducing the risk of ocular complications after HSCT.

COVID-19 in Children With Blood and Cancer Disorders: What Do We Know So Far?

Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Cancer Institute Medanta The Medicity Hospital, Gurgaon Haryana, India The author declares no conflict of interest.

Establishment of Pediatric Bone Marrow Transplant Unit in Public Sector Hospital, a Dream Accomplished.

<h3>Background</h3> Bone Marrow Transplant (BMT) is a highly sophisticated curative treatment of many Hematological, immunological, metabolic and Oncological conditions. Pakistan is a Lower middle income country. The treatment facilities are very limited as compared to the need of the region. Our Pediatric Hematology/Oncology unit is in one of the busy center of the country. We decided to start the First ever Public sector Pediatric Bone Marrow Transplant. <h3>Objective</h3> This study was done to know & enlighten the hurdles in establishment of BMT unit in Public Sector Hospitals in LMIC. The task to start BMT was taken as a challenge in collaboration with NIBD & BMT, Karachi, Pakistan in 2016. The Physicians and other supportive Team were sent for short term training.On return the Team started renovation of old building. In next step arrangement of instrumentation was done step by step, includes Cell separators, Platelet Aphresis Machines, HEPA Filters, CBC Analyzer, Handy Electrolyte Machine, Fridge (-80C⁰) for Cryopreservations & Plasma Storage, PRBC storage fridge and Blood grouping/Cross matching reagents and Gel Cards arranged. Then two patients with Beta Thalassemia Major were selected who had full matched sibling donors. The standard Conditioning Protocol of BU/Cy/ATG with GVHD prophylaxis Steroids/MTx and Cyclosporine started after saving the Autologus Bone Marrow Harvest. The Bone Marrow Harvest was done on both donors on same day and Infusion was done. The MNC and CD34 count were appropriate. The senior team members of Pediatric Hem/Onco department were involved and senior most staff nurses had taken care of the patients along with mothers of the patients. But unfortunately one patient died of Severe Pneumonia along with Pharyngeal abscess on day +11 and the second on +25 due to Primary engraftment Failure and severe Pulmonary Hemorrhage. The initial two patient's mortality depressed the Hospital administration as well as the Treating Team. We decided to review the supportive care techniques, restricted the entry and limited the Treating staff. After getting these improvements we again decided to start the BMT unit again in March 2018 and selected Aplastic Anemia patient of 8 years who had 6/6 matched sibling donor.The five days conditioning was done with Fludarabine, Cyclophsphamide and GVHD prophylaxis with Cyclosporin, MTX and steroids. PBSC was done on cell separator and stem cell infusion done. Patient engrafted Neutrophil on +10, Platelets on +18 and RBC on +45. Th immnunosupression was tapered off 6 months post BMT and now free of medication. Since then we have done so far total 23 patients including Aplastic Anemia, Thalassemia, Fanconi Anemia.Our success rate is 60%. I know it is far behind the international data but we are thriving to improve it day by day. <h3>Conclusion</h3> The persistent struggle is needed for establishment of BMT units in LMICs. <h3>Recommendation</h3> When there is a will, there is a way.

Evaluation of the demographic and clinical findings of pediatric patients that developed acute graft-versus-host disease after allogeneic hematopoietic stem cell

Aim: Acute graft-versus-host disease (GVHD) is an complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT), manifesting with an erythematous maculopapular rash followed by liver disease and dysfunctions of the gastrointestinal tract. This study aimed to retrospectively investigate the demographic and clinical characteristics of pediatric patients diagnosed with acute GVHD after undergoing allo-HSCT due to various hematological diseases.Material and Methods: The study included 33 pediatric patients that underwent their first allogeneic bone marrow transplantation in the Pediatric Bone Marrow Transplant Unit between 2015 and 2018 and were consecutively diagnosed with acute GVHD in consultation with the department of dermatology. The demographic characteristics, clinical findings, donor characteristics, treatments, and survival status of each patient were recorded.Results: Between 2015 and 2018, bone marrow transplantation was performed in 150 pediatric patients, of whom 33 (22%) developed acute GVHD. Of the 33 pediatric patients, 19 (57.6%) were boys and 14 (42.4%) were girls. At the time of transplantation, the mean age of the patients was 8.5 years, and the median age was 7 years. Twenty patients (60.6%) had only skin GVHD while 13 (39.4%) had skin and gastrointestinal and/or hepatic GVHD. It was found that the rashes had appeared on average 27.4 days after allo-HSCT. Palmoplantar involvement was detected in 13 patients (39.4%), painful erosion in the oral mucosa in 11 (33%), and conjunctivitis in seven (21.2%). The factors of being a male patient, being a female donor, transplantation from unrelated donors, liver involvement, and palmoplantar involvement were found to create risk of mortality, but not significantly (respectively p=0,753;p=0,145,0,66). Five patients (15%) progressed from acute to chronic GVHD. In patients that progressed from acute to chronic had, the mean donor age was higher, the mean time from transplantation to rash was longer, and oral involvement was higher, but not significantly (respectively; p=0,596;p=0,980;p=0,193.Conclusion: In acute GVHD, the skin is the first and most involved organ; therefore, dermatologists play an important role in its diagnosis. This study is important for determining the factors affecting the decrease in progression to chronic GVHD and prolonging survival.

Enhancement of Early Recognition in the Deteriorating Pediatric Bone Marrow Transplant Patient By Incorporating Blood Pressure As a Clinical Indicator

Topic Significance & Study Purpose/Background/Rationale Hematopoietic stem cell transplantation provides a curative alternative for malignant and non-malignant diagnoses, and Texas Children's Hospital's (TCH) Pediatric Bone Marrow Transplant (BMT) unit performs over 100 of these curative alternative transplants annually. Patients frequently experience clinical deterioration that results in increased morbidity and/or mortality. The purpose of this quality improvement project is to determine if the integration of blood pressure into the Pediatric Advanced Warning Score (PAWS) assessment would be an earlier predictor of initial clinical deterioration with patients in the conditioning, aplastic, engraftment and post discharge phases of treatment. Methods, Intervention, & Analysis TCH implemented the (PAWS) scoring system in 2009 as a validated and reliable scoring tool. The PAWS scoring system uses three categories of clinical indicators: behavior, cardiovascular status and respiratory status (Bell et al, 2013). BMT added blood pressure as a fourth clinical indicator for the PAWS assessment, validated the new scoring system through staff education and scoring patient scenarios and implemented in August 2018. When the early recognition algorithm triggered a score of four, the charge nurse, bedside nurse, attending physician and fellow completed a huddle to debrief on the current phase of treatment and abnormal clinical indicators to formulate a treatment plan based on the phase of transplant. Findings & Interpretation From October 2017 to July 2018, 70% (n=33) of BMT patients who required a Rapid Response Team (RRT) call were transferred to the Pediatric Intensive Care Unit (PICU). After project implementation, only 57% (n=14) of patients who required an RRT call were transferred to the PICU. Adding the blood pressure to the PAWS score decreased the initial recognition time to an average of 45 hours (range 17-62). Discussion & Implications The revised PAWS scoring tool and early recognition algorithm has demonstrated increased sensitivity to the identification of initial clinical deterioration, promoting better outcomes and decreased morbidity and mortality for our patients. We are continuing to monitor the BMT PAWS tool and patient outcomes.

676 - Improving Morale on a Large Pediatric Bone Marrow Transplant Unit

676 - Improving Morale on a Large Pediatric Bone Marrow Transplant Unit

382 - Sustained Reduction in Cardiac Monitor Alarms in a Pediatric Bone Marrow Transplant Unit

382 - Sustained Reduction in Cardiac Monitor Alarms in a Pediatric Bone Marrow Transplant Unit

Molecular Epidemiological Investigation of Human Parainfluenza 3 Virus Outbreak in a Pediatric Bone Marrow Transplantation Unit

BackgroundHuman parainfluenza virus 3 (hPIV3), a common cause of respiratory infections in children, can cause nosocomial outbreaks in patients undergoing hematopoietic stem cell transplantation, resulting in significant morbidity and mortality. Between July and August 2016, an increased number of hPIV3 infections were noted in a pediatric bone marrow transplant unit (BMT). Two patients were identified in late July and 4 patients in August. We undertook molecular typing of hPIV3 to determine whether cases represented multiple introductions of community virus strains or patient to patient transmission of a single strain. Previous reports of molecular typing have targeted either the F (fusion protein) gene or HN (hemagglutinin-neuraminidase) gene. We compared results using both methods direct from clinical specimens.MethodsNasopharyngeal (NP) swabs from 6 patients in BMT ward and 6 patients hospitalized on other wards had hPIV3 detected by the Luminex NxTAG Respiratory Pathogen Panel over 2 months. For the F gene a single pair of primers were used to first amplify then sequence a 278 basepair (bp) region by reverse-transcriptase PCR (RT-PCR). For HN gene a 1719 bp region was amplified using nested RT-PCR, then sequenced with 6 sets of overlapping primers. The resulting contigs were assembled manually with ContigExpress. Phylogenetic analysis of assembled sequences was performed in MEGA7 using the maximum likelihood method.ResultsFor the HN gene sequence of 1715 bp was obtained for 10 of 12 patients (5 in each group). Phylogenetic analysis of HN sequences indicated 2 distinct hPIV3 lineages (Figure 1). The 5 BMT patients differed by a maximum of 1bp, while 5 samples from other wards differed by 14 to 57 bp. For the F gene only 98 bp of common sequence was obtained for 7 patients, all of whom had HN gene sequences available. Phylogenetic analysis of F gene sequence also supported the presence of 2 distinct lineages.ConclusionMolecular typing of hPIV3 suggests there was transmission of a single hPIV3 strain within the BMT unit despite protective isolation of all BMT patients in positive pressure single rooms and the use of contact and droplet precautions for infected cases. We found sequencing the HN gene more informative than sequencing the F gene.Disclosures All authors: No reported disclosures.

543 - Decrease Clabsi Through Central Line Re-Education on the Pediatric Oncology and Bone Marrow Transplant Unit

543 - Decrease Clabsi Through Central Line Re-Education on the Pediatric Oncology and Bone Marrow Transplant Unit

The Practices and Meanings of Care for Nurses Working on a Pediatric Bone Marrow Transplant Unit.

Bone marrow transplant (BMT) units are stressful work environments with high staff burnout, anxiety, and turnover. A qualitative study was undertaken to better understand care for nurses within the context of their clinical practice on a pediatric BMT unit. Understanding care practices for BMT nurses will allow us to design interventions and provide appropriate support for this subspecialty of nurses. Focus groups were held with 24 nurses as key participants, and 2 focus groups with general participants: unit management (N = 2) and caregivers of inpatients (N = 7). Data were analyzed using a thematic analysis. Data were transcribed verbatim and coded to consensus by members of the research team. Five themes emerged from the data: ( a) experiencing stressful situations that impede care, ( b) growing and developing personally and professionally, ( c) providing trustworthy and respectful care, ( d) acquiring meaningful coping skills, and ( e) sharing with others versus isolation. Stress management, professional development, and interdisciplinary communication were areas that emerged for potential intervention.

Caring for the Cutaneous: Skin Resource Nurse on a Pediatric Bone Marrow Transplant Unit

Caring for the Cutaneous: Skin Resource Nurse on a Pediatric Bone Marrow Transplant Unit

A team-based approach to reducing cardiac monitor alarms.

Excessive cardiac monitor alarms lead to desensitization and alarm fatigue. We created and implemented a standardized cardiac monitor care process (CMCP) on a 24-bed pediatric bone marrow transplant unit. The aim of this project was to decrease monitor alarms through the use of team-based standardized care and processes. Using small tests of change, we developed and implemented a standardized CMCP that included: (1) a process for initial ordering of monitor parameters based on age-appropriate standards; (2) pain-free daily replacement of electrodes; (3) daily individualized assessment of cardiac monitor parameters; and (4) a reliable method for appropriate discontinuation of monitor. The Model for Improvement was used to design, test, and implement changes. The changes that were implemented after testing and adaptation were: family/patient engagement in the CMCP; creation of a monitor care log to address parameters, lead changes, and discontinuation; development of a pain-free process for electrode removal; and customized monitor delay and customized threshold parameters. From January to November 2013, percent compliance with each of the 4 components of the CMCP increased. Overall compliance with the CMCP increased from a median of 38% to 95%. During this time, the median number of alarms per patient-day decreased from 180 to 40. Implementation of the standardized CMCP resulted in a significant decrease in cardiac monitor alarms per patient day. We recommend a team-based approach to monitor care, including individualized assessment of monitor parameters, daily lead change, and proper discontinuation of the monitors.

“A Day in My life” Photography Project

A photovoice project was conducted with pediatric bone marrow transplant (BMT) patients to examine their coping skills and interpretation of their experience during a BMT, especially when hospitalized. We also wanted to determine how photovoice could be used within a pediatric BMT unit. Sixteen children (ages 4-14) and 2 young adults (ages 22 and 25) from a pediatric BMT unit participated in the project. Six BMT outpatients participated in the data analysis and evaluation phase. Fourteen clinical staff evaluated the impact of the project on their practice. Three primary themes emerged from the pre- and post-BMT photos, accompanying detailed notes, and BMT outpatient analysis of the photos: (a) BMT is "torture," (b) BMT is "time slipping away," and (c) BMT requires normalization, comfort, distraction, and support. BMT patients and staff concluded that photovoice helped express and release emotions regarding the challenges of BMT. BMT staff noted that the results of this project reminded them of the importance of being patient-centered and mindful of patient experience and the therapeutic relationship.