Implementation of Nurse-Driven Oral Care for Inpatient Oncology Patients Receiving Chemotherapy To Reduce Mucosal Barrier Injury Associated Bloodstream Infections

PURPOSE The purpose of this project was to reduce unit CLABSI rates by targeting mucosal barrier injury associated bloodstream infections through implementation of nurse-driven diligent oral care for all inpatient oncology patients receiving chemotherapy. BACKGROUND The project was implemented on a 23-bed inpatient oncology unit in a county, safety-net hospital in north Texas. METHODOLOGY The project utilized the PDSA framework for implementing nurse-driven oral care for all inpatient oncology patients receiving chemotherapy. Staff and patients were educated on the ideal frequency and methods of performing oral care during the project. Patients were provided unit-supplied oral hygiene items on admission. Nursing staff conducted daily rounds on appropriate patients to assess oral care methods, frequency, and the presence of appropriate supplies. A unit-developed audit tool was utilized to track patient compliance with the intervention, nursing documentation, and the presence of an order for oral care in the EMR. Multiple contacts for patients and staff were assessed when auditing these measures. RESULTS After implementation of nurse-driven oral care for three months, the target unit noted zero CLABSI events. 97.7% of patients reported compliance with the intervention. The findings suggest that diligent oral care can improve CLABSI rates by targeting mucosal barrier injury prevention in patients receiving chemotherapy. IMPLICATIONS Nurse-driven oral care can potentially decrease CLABSI rates and thus improve patient outcomes and healthcare costs. Sustainability of this intervention is contingent upon ongoing education for new staff members and patients and continued monitoring of CLABSI events.