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Course Name

Clinical Improvement Project II CAPSTONE

Graduation Year

12-2025

Faculty Advisor

Dian Baker

Abstract

Background: Central line-associated bloodstream infections (CLABSIs) impact pediatric patient outcomes, increasing mortality, hospital stays, and healthcare costs. At Sutter Medical Center Sacramento (SMCS), the CLABSI prevention bundle includes proper line care, dressing assessments, and hygiene practices, including twice-daily oral care, daily linen changes, and chlorhexidine gluconate (CHG) bathing. Sutter found their CLABSI bundle compliance at approximately 76–78%, with oral hygiene identified as the most frequent gap in care.

Aim: This quality improvement project, partnered with SMCS, targeted oral care compliance to enhance overall bundle adherence, strengthen staff-leadership communication, and ultimately reduce CLABSI rates in the hematology/oncology units. In a wider perspective, this project sought to support Sutter’s broader commitment to preventing hospital-acquired infections through evidence-based care.

Methods: Targeting all 80 registered nurses and 9 technicians working on the pediatric and hematology/oncology units at SMCS, staff education was delivered through Tuesday Teaching Tip (“T3”) emails, huddle reminders, and weekly patient rounds, focusing on proper oral hygiene practices for patients with central lines. Educational hygiene flyers were provided to patients and families during weekly oncology rounding to deliver individualized education and assess oral care practices. Kamishibai cards (K-card) audits tracked pre- and post-intervention bundle adherence to evaluate the effectiveness in improving oral care compliance and decreasing CLABSI rates.

Results: Mean oral care compliance improved from 71% (SD = 0.30) during the pre-intervention phase to 91% (SD = 0.06) in phase 1 and 87% (SD = 0.03) in phase 2. The difference between the pre-intervention phase and phase 1 was statistically significant (p = .043). The rolling 12- month CLABSI rate decreased from 0.87 (SD = 0.40) to 0.61 (SD = 0.24) per 1,000 catheter days by phase 2, though changes were not statistically significant (p > .05). Overall, the intervention was associated with improved oral care compliance and a downward trend in CLABSI rates.

Conclusion: This project was used to enhance and improve oral hygiene compliance in hematology/oncology pediatric patients with central lines at SMCS as a strategy to reduce CLABSIs. This supported an existing quality improvement project at SMCS and aimed to reinforce best practices through two primary interventions: nurse education through “T3” email updates and huddle reminders, as well as the implementation of an educational hygiene flyer for patients and their families. Through these interventions, oral care compliance increased within the unit, ranging between 80% and 90%, and is expected to continue improving over the next several months.


Keywords

Central line-associated bloodstream infections, CLABSIs, oral care, oral hygiene, oral health, pediatrics, education, nurses, quality improvement

Hygiene Heroes: Strengthening Oral Hygiene to Reduce Central Line-Associated Bloodstream Infections in Pediatric Hematology/Oncology Patients

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