Bone marrow transplantation (BMT), also known as hematopoietic cell transplantation (HCT), is a well-established treatment option for patients with hematologic malignancies, immune disorders, and other serious diseases. The procedure involves harvesting hematopoietic stem cells from bone marrow or peripheral blood, followed by their infusion into the same patient (autologous transplantation) or a different recipient (allogeneic transplantation).
Given its complexity and associated risks, this type of transplantation requires high coordination, rigorous infection prevention measures, continuous patient monitoring, and constant quality improvement processes. Nurses play a central role within bone marrow transplant programs, providing expert care and contributing to quality management at all stages of the transplant process.
Their responsibilities include infection control, regulatory compliance, staff training, performance improvement, patient and family education, as well as interdisciplinary collaboration. Their clinical expertise and commitment to quality standards are critical to optimizing clinical outcomes, ensuring safety, and maintaining compliance with regulatory and accreditation requirements.
This article explores the role of nurses as quality managers in bone marrow transplant programs, highlighting their contributions to patient safety, infection prevention, monitoring of quality indicators, management of adverse events, staff education, and use of technology to support continuous improvement.
Ensure patient safety and infection control
Nurses play a crucial role in infection control, especially in hematopoietic stem cell transplantation programs, given the profound immunosuppression of patients. Transplant recipients are extremely vulnerable to infections, which can cause serious and life-threatening complications. Infections are still a major cause of morbidity and mortality, particularly in allogeneic transplants.
Therefore, it is essential to have an adequately trained nursing team to assess, prevent, detect and manage infections throughout the transplantation journey. The immunosuppressive effects of chemotherapy and radiation therapy further increase the patient's vulnerability.
Nurses engaged in quality management are responsible for ensuring strict adherence to infection control protocols. These include strict hand hygiene practices and the proper use of personal protective equipment (PPE) by staff and visitors.
In addition, nurses develop and implement specific protocols to reduce the incidence of central venous catheter-associated bloodstream infections, conduct regular surveillance activities for nosocomial infections, and design targeted strategies to prevent them in transplant patients. Other preventive measures include the use of positive pressure isolation rooms with HEPA filters for immunocompromised patients, particularly to protect against airborne fungal infections such as Aspergillosis.
Key prevention and control measures also include respiratory hygiene, safe handling of sanitary equipment, environmental cleanliness, handling of linens, management of spills of blood or body fluids, waste disposal, and management of exposures. Among these, hand hygiene remains an essential component of standard precautions for all patients.
Monitoring of quality indicators and performance improvement
Data-driven decision making is essential for improving transplant outcomes. Nurses with quality management responsibilities contribute significantly to the development and monitoring of key performance indicators (KPIs), which support the ongoing evaluation of BMT program effectiveness. These indicators include:
- Infection rates
- Rooting success (time required for the transplanted cells to start functioning)
- Readmission rates and patient follow-up
- Post-transplant mortality and patient quality of life
- Levels of patient satisfaction
Analysis of this data allows nurses to identify trends, monitor clinical performance, and implement targeted interventions to improve clinical outcomes and program efficiency.
A study published in Haematologica showed that accredited quality improvement programs can significantly reduce transplant-related complications, with an overall improvement of 10% to 15%.
Ensure compliance with regulatory and accreditation standards
BMT programs must meet rigorous standards set by regulatory and accreditation bodies. Policies and procedures must be aligned with the FACT-JACIE international standards for cell therapy, jointly developed by the Foundation for the Accreditation of Cellular Therapy (FACT) and the ISCT-Europe & EBMT Joint Accreditation Committee (JACIE). In addition, programs must comply with general hospital accreditation requirements, such as those established by The Joint Commission (JCI).
Nurses play a key role in ensuring adherence to these standards by conducting internal audits, maintaining accurate documentation and leading staff education sessions. FACT-JACIE-accredited programs show greater adherence to best practices, resulting in improvements in transplant success rates and patient safety.
Reporting and management of adverse events
Quality management nurses are responsible for reporting and investigating adverse events and near misses in order to strengthen patient safety. All relevant events should be documented in quality management reports and shared with relevant teams, including clinical, collection, and processing teams. A structured audit process supports the identification of root causes and ensures that corrective and preventive measures are implemented effectively to reduce the risk of recurrence.
Training, upgrading and skills development
Continuing education and skills development are essential to ensure high-quality care in BMT programs. Nurses with quality coordination roles manage educational initiatives, including the creation of structured programs, staff orientation, mentoring models, and both basic and specialized training courses. They also conduct mandatory competency assessments and organize workshops on infection control, emergency protocols, and transplant complications.
Education of patients and family members
Adherence to post-transplant care guidelines by patients and family members is critical to long-term success. Quality assurance nurses develop educational programs to improve understanding of infection prevention measures, therapeutic adherence, and early recognition of complications such as graft-versus-host disease (GVHD).
They also train patients, family members and visitors on proper hand hygiene practices and provide clear instructions to reduce infectious risk.
Promoting interdisciplinary collaboration
Bone marrow transplantation requires effective collaboration among health care professionals from different disciplines. Regular interdisciplinary meetings promote coordinated care, reduce clinical errors and improve overall program efficiency.
Evidence shows that teamwork contributes to shorter hospital stays and better clinical outcomes.
Leveraging technology for quality improvement
Modern BMT programs increasingly adopt digital tools and artificial intelligence to support patient care and safety. Nurses with quality functions oversee the implementation of electronic health records, telemedicine systems, and AI-based infection surveillance technologies.
According to a study published in Transplantation and Cellular Therapy, infection monitoring using artificial intelligence reduced sepsis mortality by 30 percent.
Conclusion
Nurses in quality management roles are essential to the success of bone marrow transplant programs. Their expertise in patient safety, regulatory compliance, performance improvement, and staff education ensures high-quality, person-centered care.
As BMT programs evolve, nurses will continue to drive innovation and continuous improvement, contributing to improved clinical outcomes and the maintenance of high standards in this highly specialized field.
References
- Standard precautions of infection control(https://www.dhs.wisconsin.gov/ic/precautions.htm)
- The Centers for Disease Control and Prevention have reported significant reductions in healthcare-associated infections through effective prevention strategies (CDC, 2023). https://arpsp.cdc.gov/profile/national-progress-2023/united-states
- Use of the quality management system "JACIE" and outcome after hematopoietic stem cell transplantation 2014 May;99(5):908-915. doi: 10.3324/haematol.2013.096461
- Patel, H., et al. (2022). Artificial Intelligence in Infection Surveillance for BMT Patients. Transplantation and Cellular Therapy.
- Drozd, A. | Flesch, L. | Mott, B. | Davies, S. | Grimley, M. | Dandoy, C. | Napoli, J. | Orndorff, L. | Schultz, J. | Nestor, J. | Corbett, C. | Meyer, R. | Best, D. (2020) Achieving Quality BMT Outcomes through Multidisciplinary Collaboration and Engagement
- Kenyon, A. Babic (eds.), The European Blood and Marrow Transplantation Textbook for Nurses, https://doi.org/10.1007/978-3-031-23394-4_1
- Nursing as a balancing act in allogeneic hematopoietic cell transplantation-nurses' experiences through participation in workshops https://doi.org/10.1016/j.ejon.2023.102300
- Advancing Patient Safety: The Future of Artificial Intelligence in Mitigating Healthcare-Associated Infections: A Systematic Review https://pubmed.ncbi.nlm.nih.gov/39408177/
- International Accreditation Standards Manual Eight Edition (2021) 8th edition of FACT-JACIE Standards | EBMT
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