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Topic Significance & Study Purpose/Background/Rationale Preventing central line-associated blood stream infections (CLABSIs) is a priority in blood and marrow transplantation (BMT). A central line infection is both costly and potentially a fatal event. Our hybrid unit of 33 inpatient beds and seven outpatient rooms is designed for hematology/oncology patients receiving autologous and allogeneic BMT. According to the National Healthcare Safety Network (2013), our unit is classified as a hematology/oncology unit, with a CLABSI benchmark of 1.4 per 1000 central line days, not a BMT unit with a rate of 2.6 (NHSN, 2013). In 2016, an analysis of our practice identified opportunities for improvement based on a BMT CLABSI rate of 2.5. The goal of this quality improvement initiative was to reduce the CLABSI rate below the benchmark of 1.4, a 44% reduction. Methods, Intervention, & Analysis Our approach included: a collaborative unit-based task force of direct care nurses, nursing assistants, nurse managers, advanced practice providers, infection preventionists and quality specialists; standardizing central line catheters for BMT patients; and clinical surveillance with a focus on line care. Nurse-sensitive practice changes included: education of BMT nurses and assistants, focused risk awareness and practice “musts”; continual review of data at all task force and staff meetings; minimizing intravenous tubing disconnections; product changes for line care; and focused patient education. Findings & Interpretation Subsequent to interventions outlined below, we achieved a remarkable improvement, achieving a rate much less than the national benchmark of 1.4. With the exception of mucosal barrier injury-related CLABSIs, the 2016 CLABSI rate of 2.5 was reduced to zero in 2017, and 0.59 in 2018 (attributed to an increase in allogeneic transplant volume and acuity). The current 2019 rate is zero! Discussion & Implications CLABSI prevention is best accomplished by creating a team environment, where everyone involved is a stakeholder. Reflection and shared decision-making can result in a significant, sustained CLABSI rate reduction in BMT.

Transformative Leadership: A Model for Building a Comprehensive Cellular Therapy Program Partnership Introduction The third largest public safety net healthcare system in the United States established an outpatient Hematopoietic Cell Transplantation (HCT) program in 2007. In 2011, the Certificate of Need was obtained from the State of Florida to begin an inpatient (HCT) program. After ten years of low volumes leading to an inability to obtain allogeneic accreditation from the Foundation of Accreditation of Cellular Therapy (FACT), a transformative partnership for HCT was launched, in 2017, with a NCI designated comprehensive cancer center. The overall purpose of the partnership is to emulate the structure and quality of the NCI designated center's program and to increase patient access to HCT and other advanced cellular therapies in South Florida. Methods The HCT physicians and advanced practice providers are employed by the NCI center, but practice at the satellite campus. Essential program team members including the department administrator, HCT coordinators, quality program professionals, pharmacy, nursing and laboratory teams are employed by the public healthcare system. The partnership agreement is focused on quality indicators as the measure of success. A joint governance and a joint clinical operating committee, comprised of senior leadership from both institutions, were established to review metrics and quarterly outcomes, to ensure the partnership is meeting the clinical and operational program goals. Intellectual property including protocols, Standard Operating Procedures (SOP) for transplant, clinical pathways and quality initiatives are provided by the NCI center and adapted to fit the need of the program. The partnership also allows for a collaborative exchange of process improvements and best practices between operational areas including, information technology, managed care, revenue cycle, nursing, pharmacy, and laboratory. Joint educational activities include weekly grand rounds and monthly collaborative teleconferences for nursing, pharmacy, quality and coordination. Shared patient data allows for research activity between the two centers. Outcomes In the two years of partnership, the program has achieved FACT accreditation for autologous and allogeneic transplant. Prior to the partnership, the institution had referred out 149 patients for allogeneic transplant over the course of 10 years. Post-partnership, only three patients required referral for services the institution does not currently provide. Within one year of partnership launch, the program achieved certification as a National Marrow Donor Program Transplant Center and was approved as a center of excellence (COE) with three major managed care networks. Conclusion: Well-designed partnerships can allow for the establishment of accredited transplant and cellular therapy programs.