Perianal infection is common in HSCT patients. Due to mucosal barrier damage and severe immunosuppression from conditioning regimens, they are at high risk of it. Critically ill HSCT patients especially need precise interventions to shorten infection control response time and reduce progression risk.

Objective: This study aims to construct a data-driven continuous improvement system for nursing quality in perianal infection prevention and control for patients in HSCT laminar flow wards. Through the closed-loop management of “data monitoring - problem analysis - measure optimization - effect verification”, it is intended to reduce the perianal infection rate of patients, improve nursing accuracy, and provide a practical paradigm for infection prevention and control.

Methods: A total of 809 patients who received HSCT in our center from January 2020 to December 2024 were continuously included as research subjects. Disease diagnosis: 372 cases of ALL (46%), 189 cases of AML (23.4%), 170 cases of lymphoma (21%), 22 cases of MDS, 18 cases of AA, 38 cases of myeloma and others. Gender: 451 males (55.7%) and 358 females (44.3%). Age: 49 cases under 3 years old, 254 cases aged 4-14 years, 462 cases aged 15-59 years, and 44 cases aged 60 years and above. Transplant types: 599 cases of haploidentical transplantation (74%), 155 cases of fully matched transplantation (19.2%), 187 cases of unrelated transplantation (23.1%), and 224 cases of secondary transplantation (27.7%). Conditioning regimens: including 399 cases with total body irradiation (TBI), 320 cases with busulfan (BU), 272 cases with etoposide, 54 cases with cyclophosphamide (CTX), as well as other drugs such as fludarabine, ATG, cytarabine, thiotepa, etc. (patients often receive combinations containing multiple drugs). Since 2020, a scale covering two core outcome indicators, namely the perianal mucosal damage rate and perianal infection rate, as well as a total of 13 core indicators including basic information, treatment plan, laboratory indicators, perianal conditions, nursing measures, pain indicators, occurrence and duration, has been established and applied for continuous monitoring. The nursing team conducted dynamic analysis based on monthly and annual monitoring data to continuously optimize the nursing plan. In 2023, on the basis of traditional empirical nursing measures, an innovative comprehensive nursing intervention plan was integrated and implemented (introducing Picima and Quanyuhe ointment products with technologies of rapid repair, pain relief, anti-infection and cell regeneration), and sequential application of water-based and oil-based agents was adopted to improve the absorption efficiency of ingredients, combined with cutting-edge theories of wound care.

Results: After implementing data-driven closed-loop management and comprehensively optimizing the nursing plan, both core outcome indicators were significantly improved. The perianal mucosal damage rates from 2020 to 2024 were 8.9%, 9.7%, 14.7%, 8.1% and 7.4% respectively; the perianal mucosal infection rates were 0.8%, 1.8%, 0.6%, 0.2% and 0% respectively. The damage-infection conversion rate decreased in 2022, and in the subsequent years, the decrease in the damage-infection conversion rate turned into a decrease in the damage rate. By the end of the study (2024), zero occurrence of perianal mucosal infection was achieved, and the mucositis that occurred was only mild, without progressing to perianal abscess or bloodstream infection, and the implantation and discharge effects of the transplant仓 were not affected by perianal problems.

Conclusion: The data-driven closed-loop management model combined with continuously improved and optimized nursing measures can effectively reduce the incidence of perianal infection. Through the circular mechanism of “data feedback - measure iteration - innovative application”, precise protection from the conditioning period to the immune recovery period is realized. This model has successfully promoted the fundamental transformation of nursing practice from experience-based to data-driven and precise. Through 5 years of efforts, the team has significantly reduced the perianal mucosal infection rate to 0%, providing a scientific and practical systematic path for the prevention and control of infectious complications, which has important clinical value for improving patient safety and transplant success rate.

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2025
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