#19: Challenges and Opportunities for the Improvement of Care and Prevention of Infections in Institutions Serving Cancer Patients in Bolivia
Authors: Rodriguez-Auad J P , Velasco P , Salas B , Coleoni E , Sardinas S , Homsi M , Taponnier G , Ocampo D , Acebo J , Davidas M , Gutierrez I , Caniza M 
Published: March 2021

Abstract

Background
Children with cancer in low-income countries are at risk of dying 10 times more than children with similar disease in countries with more resources; and more than half of the deaths are due to infectious complications. Risks of infectious mortality could be reduced by systematically implementing care and infection prevention, for which the collaboration and commitment of health personnel are required. We describe the structure, execution, and results of the first symposium and workshop on basic aspects of care and prevention of infections in children with cancer for health personnel in three pediatric oncology units in Bolivia.

Methods
We conducted a quality improvement study of training, where a symposium and workshop was convened to the health personnel in charge of the care of children with cancer of the main pediatric cancer centers in Bolivia. A survey was conducted regarding the current state of care for children with cancer in their respective institutions, as well as the situational perception regarding the care and prevention of infections. At the same time, a symposium was held with presentations by experts regarding hand hygiene, blood cultures, isolation precautions, and safe vascular access; After that, a participatory workshop was developed that included: simulation exercises, feedback on basic points of the four topics, decisions and choices of improvements to be implemented and finally a commitment was made by the attendees to apply these improvements in their institutions.

Results
Fifty-nine health workers from the only three pediatric cancer centers in Bolivia attended the workshop. Currently, these healthcare professionals see a total of 345 children with cancer. There are 61 new cases annually, approximately 6 patients per month, and with a percentage of abandonment of 20%. In these three centers, peripheral catheters, implantable catheters, and nontunneled catheters are used in 90%, 27%, and 36% of cases, respectively. In relation to patient care, only 26% receive antibiotics in the first hour after hospital admission, 73% have an infection control program, 63% have infection policies and procedures and 76% do not know the infection rates associated with their institution. Through interactive discussion in the workshop, health staff involvement and training emerged as the main priority. The improvements selected by the participants were: training of intravenous therapy teams and increasing health personnel (vascular access); reminders for medical and nonmedical professionals (hand hygiene), ongoing training, monitoring of practices, education, and training in sampling (blood culture); and training of leaders for services (isolation precautions). The written commitment was made by all the participants and an agenda was made to monitor the progress of the selected improvements.

Conclusions
The group strategy of theoretical-practical training with a motivational and participatory background is a tool that can help health personnel to commit to improving the care of children with cancer in Bolivia. Follow-up is being conducted for the next 6 months to determine the long-term impact of this strategy.