Preventing Infections in Cancer Patients: What Nurses Can Do
By Juliet Wilkinson, RN, BSN, contributor
Cancer patients suffer special challenges when fighting off infections. According to the Centers for Disease Control and Prevention (CDC), more than 60,000 cancer patients are hospitalized each year in the United States due to infections, and a cancer patient dies from a preventable infection every two hours. When a patient is actively undergoing treatment, even a small paper cut or shaving nick can provide an entryway for pathogens, which require intense treatment when paired with the neutropenic state.
Common respiratory infections are also dangerous at this stage, because neutrophils--the white blood cells that provide the primary line of defense against infection--have been temporarily killed off by chemotherapy and radiation therapy treatments. The most vulnerable stage of neutropenia, when the level of neutrophils is lowest, will generally occur 7 to 12 days following the last cancer treatment session.
Although oncology outpatient clinics are a major focus of attention in preventing infections, it is not just travel nurses working in oncology units or cancer centers who come in contact with these patients; in fact, every nurse needs to be aware of cancer patients’ needs for specialized care and education.
You can make a difference
“Nurses play a vital role in caring for cancer patients, and their actions and recommendations alone can make a lasting impression on a cancer patient,” explained Lisa Richardson, M.D., medical officer with the CDC’s Division of Cancer Prevention and Control. Even seemingly commonplace information supplied to a cancer patient and his or her family can make a huge difference in their outcome by helping them avoid unnecessary infections during this critical time.
Don’t discount the simple stuff
In today’s high-tech medical environment, it is sometimes easy to forget the most basic infection-reducing measures. Florence Nightingale stressed the importance of a clean environment and hand washing as far back as the Crimean War, and the benefits of this simple measure have been proven many times over in the decades since.
“One of the most important messages a nurse can share with their patient is the importance of hand washing--for anyone who comes into contact with the patient. This one action helps reduce infections in everyone, including the cancer patient at risk for infection.” Teach your patient and his or her loved ones how simple hand washing can eliminate the germs that lead to opportunistic infection. Stress the importance of how and when to wash their hands.
Take ‘3 Steps Toward’ helping your patients
It’s been one year since the CDC, paired with the biotechnology company Amgen, launched the Preventing Infections in Cancer Patients program. The campaign includes an interactive website called “3 Steps Toward,” found at www.PreventCancerInfections.org, which is available to help patients, families and healthcare providers; each type of user will find an online questionnaire that assesses and will ultimately tailor the recommendations for decreasing the patient’s risk of infection.
As a nurse using the system for your patient, you will not be required to give away protected health information. Rather, questions are limited to factors such as the patient’s age range, type of malignancy, and propensity toward neutropenia.
“PreventCancerInfections.org is an excellent tool for nurses to use with their cancer patients. Not only does it explain in very easy-to-understand language why cancer patients are more vulnerable for getting an infection, this information is meant to empower patients to take action steps to take better care of themselves,” stated Richardson.
It is unlikely that a nurse will spend every second by a cancer patient’s side. Therefore, it’s vital that you give the patient--and their friends and family--the tools necessary to avoid infection.
Provide patient-specific education
How much does your patient know about infection prevention? Instead of assuming, you can use the 3 Steps Toward website tool (or any other facility-approved health and knowledge assessment), to ascertain a place to initiate education and discern where you need to focus your time. For instance, if your patient has pets at home, you may want to teach him or her about the risks of acquiring infections from cleaning up after their pets, as well as simple ways to deal with this challenge, such as wearing vinyl gloves.
By tailoring your education to the patient’s specific needs, you can help that patient in ways that basic brochures, websites and handouts on neutropenia cannot.
Teach warning signs
More than likely, your patient will have some degree of neutropenia following treatment. Regardless of everyone’s best efforts, there is still a chance that he or she will acquire an infection. Your patient needs to know when he or she should contact the doctor without delay, as infections in immunocompromised cancer patients can rapidly deteriorate their health status.
The CDC encourages patients to notify their doctor if the patient suffers a fever (over 100.4), chills, shortness of breath, burning or pain with urination, a new cough or congestion, unusual discharge or redness at surgical or port sites, diarrhea or vomiting, or a new pain following chemotherapy.
Find more information:
CDC: Preventing Infections in Cancer Patients
3 Steps Toward Preventing Infections During Cancer Treatment Tool - PreventCancerInfections.org
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