Purpose/Objectives: : Children who have undergone hematopoietic cell transplant (HCT) often have prolonged hospitalizations and complex clinical courses that increase risk of delirium and functional impairment. Because of these risks, pediatric HCT patients stand to benefit from early mobilization interventions designed to mitigate long-term functional morbidity. However, these patients’ clinical complexity may hinder successful implementation of an early ambulation intervention. Some HCT patients are under contact restrictions due to colonization with bacteria producing Extended Spectrum Beta-Lactamase (ESBL). Our goal was to assess the safety and feasibility of an early mobilization initiative in pediatric HCT patients. Design/Methods: This Quality Improvement project was implemented in the Bone Marrow Transplant and Cellular Therapy Unit (Transplant Unit) of a quaternary care center specializing in the care of children with hematologic and oncologic disorders. During the study period (Jan-Oct 2022), mobilization data was obtained from nursing and physical therapy (PT) documentation in the electronic health records. The intervention was performed in June 2022, during which nurses and staff received education on safely mobilizing patients under contact precautions for ESBL-colonization outside their rooms while wearing personal protective equipment (PPE). We also collected aggregate Rectal Surveillance Culture (RSC) data, patient demographics, and clinical characterizations of patients. Descriptive statistics were performed. Results: 85 patients were included in the study, 11 patients with admission periods before and after the intervention, 39 patients with admissions before the intervention, and 35 with admissions after the intervention. There were no statistically significant differences in the demographic variables between patients admitted pre-intervention compared to patients admitted post-intervention. Patients with admissions spanning both pre- and post-intervention had higher ambulation rates (p = 0.0015) and walked farther distances with PT (p < 0.0001) before the intervention than they did after the intervention. Patients admitted pre-intervention had higher ambulation rates and ambulated longer distances with PT than those admitted post-intervention (p < 0.0001). During the period before the intervention, there were 3 patients who became colonized with ESBL-producing bacteria, compared to 4 new patients who became colonized after the intervention. Conclusion/Discussion: The intervention was unsuccessful at increasing ambulation in the target population. This may be due to pediatric HCT patients’ complex clinical courses and frequent complications, which were not assessed in this study. There was no significant increase in the rate of ESBL-producing bacterial colonization for patients on the Transplant Unit after the intervention took place. Further research should continue to address the feasibility of early rehabilitation initiatives in pediatric HCT patients, who have many risk factors for long-term functional morbidity. Citation Format: Anne Swanson, Saad Ghafoor, Kimberly Fan, Kylie James, Akshay Sharma, Xiaomeng Yuan, Haitao Pan. Implementation of an Early Mobility Initiative in a Pediatric Bone Marrow Transplant Unit [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Discovery and Innovation in Pediatric Cancer— From Biology to Breakthrough Therapies; 2025 Sep 25-28; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2025;85(18_Suppl_2):Abstract nr B051.

Background/Objectives: Children who have received hematopoietic cell transplants (HCTs) often face complex clinical courses and complications that increase their risk of functional impairments. Because of this, pediatric HCT recipients may benefit from early mobilization efforts to reduce long-term functional issues. However, early ambulation can be limited by clinical complexity and concerns about infectious transmission in HCT patients. Some patients are under contact precautions due to colonization with bacteria that produce extended-spectrum beta-lactamase (ESBL) enzymes. Our goal was to significantly increase ambulation in pediatric HCT recipients at our institution within three months of the intervention. We aimed to raise the number of ambulation events per day, the number of physical therapy (PT) visits per week, and the distance patients walked with PT per session. Methods: From January to October 2022, data on mobilization, demographics, and clinical characteristics were retrospectively collected from electronic health records. Starting in June 2022, we permitted ESBL-colonized patients to leave their rooms while wearing personal protective equipment (PPE), and we trained clinical staff about this in our QI initiative. Results: In Group 1, the ambulation rate was 1.36 times higher before the intervention than after, with an effect size of 0.3042 (p = 0.004 *). The ambulation rate in Group 2, admitted before the intervention, was 1.33 times higher than in Group 3, admitted after the intervention, with an effect size of 0.2856 (p = 0.016 *). Conclusions: The initiative did not increase ambulation among the targeted group. Patients ambulated more before the intervention, though these results lack statistical power. The lack of success of the intervention may be due to various factors, including the short monitoring period, retrospective data collection, difficulties with PPE use among young patients, and uncollected confounding variables related to clinical status.