D105-14 Improving Nontuberculous Mycobacteria Screening in Pediatric Cystic Fibrosis Patients Through a Quality Improvement Initiative

Abstract Introduction Nontuberculous Mycobacteria (NTM) are ubiquitous organisms capable of causing severe lung damage in pediatric patients with Cystic Fibrosis (CF) (1,2). The CF Foundation recommends annual screening for NTM for patients who spontaneously expectorate. Acceptable specimens for screening include sputum, induced sputum, bronchoalveolar lavage, or bronchial washing (3). Baseline national screening rates for pediatric CF programs were less than 60%, and our CF center has been either at or below that level for several years. To address this gap, our CF team initiated a Quality Improvement (QI) project aimed at increasing screening rates to 90% by December 2025. Methods A multidisciplinary team was formed to identify barriers to NTM screening and to test interventions for improving screening rates, refining them using Plan-Do-Study-Act (PDSA) cycles. Before project implementation, the center lacked a standardized process for identifying and screening patients at risk for NTM infection. Utilization of the existing clinic questionnaire was inconsistent, and standing culture orders placed up to a year in advance often resulted in specimen mislabeling. A standardized process for NTM screening was developed using CF guidelines (3). The existing questionnaire incorporated two additional questions: one to assess whether the patient could produce sputum during the current visit, and another to determine if the patient had produced sputum within the previous month. No baseline data existed regarding patients’ ability to produce sputum. Based on questionnaire responses, nurses placed orders for the appropriate specimen—either sputum or an oropharyngeal swab—avoiding standing orders. Patients who had not been screened in the prior year were identified through weekly screening reports for patients scheduled to be seen the following week and shared with the CF QI team. Trends in screening were monitored using run charts, allowing continuous evaluation of process improvements. The number of completed forms served as a process measure to assess adherence. Results Between March 2025 and October 2025, weekly form completion averaged 73%. Analysis of questionnaire responses revealed that 12% of our patients could produce sputum. Overall, 95% of eligible patients were successfully screened. Among screened patients, 18% had never undergone screening before, 20% had not been screened in over one year, and 29% reported intermittent sputum production at home. Conclusion This QI project demonstrates that systematic, high-quality methods can significantly enhance NTM screening in pediatric CF patients. Standardized workflows, targeted questionnaires, process monitoring, and using PDSA cycles contributed to increased screening and improved identification of patients requiring NTM testing. This abstract is funded by: None