Infection Control in Oncology Nursing

About 1,660,290 new cancer cases are expected to be diagnosed in 2013, and approximately 580,350 Americans are projected to die of cancer. That’s almost 1,600 people a day.

It has been estimated that each year, 60,000 cancer patients are hospitalized in the U.S. for chemotherapy-induced neutropenia and one in 14 (or 4,100) will die from this complication.

Despite advances in oncology care, infections remain a major cause of morbidity and mortality among cancer patients.3,4,5 Risk of infection remains a constant complication for patients diagnosed with cancer throughout the disease trajectory.

Several factors predispose cancer patients to developing infections, including immunosuppression from their underlying cancer and chemotherapy treatment. Frequent contact with healthcare settings may expose them to other patients with transmissible infections. Thus, careful attention to proper infection prevention practices is essential to the care of cancer patients to minimize their risks for infectious complications.

To help combat this challenge, the Centers for Disease Control and Prevention launched its Preventing Infections in Cancer Patients campaign in October 2011. The CDC program offers healthcare providers, patients and families a set of user-friendly resources designed to help reduce the risk of life-threatening infections during a cancer patient’s treatment.

The role these resources played at Atlanticare Cancer Care Institute, Egg Harbor Township, N.J., are outlined below.

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Healthcare Provider Resource

The CDC document, Basic Infection Control and Prevention Plan for Outpatient Oncology Settings,” can be used by any outpatient oncology facility to standardize and improve infection prevention practices. It is based on CDC’s evidence-based guidelines as well as relevant guidelines from professional societies and is tailored for quick implementation in outpatient oncology facilities.

This document includes key policies and procedures that will ensure a facility meets or exceeds minimal expectations of patient safety.

The medical oncology interdisciplinary team along with the infection control committee at the Atlanticare Cancer Care Institute applied this document to their practice setting.

The team conducted a gap analysis, identified areas for improvement and tracked outcomes, revised policies and procedures, and educated team members in key areas of infection control such as cleaning of infusion chairs, and respiratory hygiene.

The team consisted of the clinical director, staff nurses, pharmacists, and infection control nurses. This team read and critiqued the literature from the CDC and the Oncology Nursing Society’s (ONS) Putting Evidence into Practice (PEP), and held monthly team meetings to assess progress and goal attainment.

Data was collected by staff for aggregate cleanliness and documentation of patient education regarding preventing an infection. Feedback was obtained from patients via their follow-up phone call to ascertain whether the nurse educated them on infection control strategies during their cancer treatment.

Additionally, the team formulated and implemented plans for development and integration of guidelines into practice:

  • annual infection control education for oncology staff;
  • policy gap analysis and development;
  • integration of recommendations into the medical record documentation; and
  • development of patient educational materials.

This team also conducted educational sessions to all clinical and non-clinical staff and housekeeping personnel regarding infection control prevention utilizing the CDC document as a guide for the sessions.

The team also created postings within the department educating patients/caregivers on cough etiquette and respiratory hygiene. These sessions continue on an annual basis for the department and remain a core competency.

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Patient & Caregiver Resource

My facility also utilized the patient and caregiver web site www.PreventCancerInfections.org as our nursing staff incorporated it into their chemotherapy education sessions with patients and caregivers.

Our nursing staff extended their reach and further helped to educate cancer patients and caregivers by also offering a live educational program in conjunction with the local Gilda’s Club.

This setting allowed for an interactive demonstration of PreventCancerInfections.org so the audience could immediately see how the website’s risk assessment questionnaire determined a person’s risk for developing neutropenia and subsequent infections.

According to Lisa Richardson, MD, MPH, an oncologist and associate director for science in CDC’s Division of Cancer Prevention and Control, the federal agency used knowledge gained through formative research to tailor messages and launch a website aimed at helping cancer patients understand their risk for developing a low white blood cell count and steps they can take to lower their risk of infection when they are most vulnerable.

“As nurses, you know that cancer patients with neutropenia are more susceptible to infections,” she says. “Their risk for acquiring a life-threatening infection increases progressively with both the duration and magnitude of neutropenia.”

Read more from CDC’s Richardson here.

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The team tracked outcomes data over the course of one year and demonstrated:

  • an improvement of 40% from baseline in regards to documentation of patient education on prevention of infection in the medical record; and
  • a 47% increase from baseline in the area of patients self-reporting they had been educated about prevention of infection strategies by their nurse during their discharge call-back phone call.

The team also collected data for aggregate cleanliness of the infusion suite. This improved by 30% from baseline as measured by Glo Germ application on several areas of the department, including infusion chairs, nurses’ station and provider hands. Glo Germ is a product sold both in liquid and powder form that contains proven safe ingredients formulated to be the same size as bacteria, basically 5 microns in size. When used in either the powder or liquid-based form, with the use of an ultra-violet light, it simulates the spread of germs, teaching how quickly and broadly germs can be spread in a short period of time.6 This was measured by the team on a monthly basis.

The team also participated in a CDC survey study, involving on-site interviews and direct observations of medical oncology and infection control nurses on utilization of the PreventCancerInfections.org website. The data collected from this study will describe how frontline clinical staff are using materials from the website to educate patients with cancer. Our team was chosen as one of the sites for this CDC Study.

A team approach, coupled with the integration of evidence-based standards, enabled the medical oncology and infection control teams to improve patient educational resources, raise awareness of infection control and prevention practices in this high-risk population, and enhance quality in the area of infection prevention in the ambulatory medical oncology setting.

References for this article can be accessed here.

Michele E. Gaguski, Clinical Director, Medical Oncology/Infusion Services, Atlanticare Cancer Care Institute, Egg Harbor Township, N.J.

Respiratory Hygiene and Cough Etiquette Flyer
If you have a respiratory infection, here’s what to do:
* Notify our receptionists upon arrival that you have these symptoms
* Cover your mouth and nose with a tissue when coughing or sneezing
* Dispose of the tissue in the nearest waste basket
* Wash your hands or use an alcohol based hand rub
Thank you for helping to reduce the spread of infection.
Source: Atlanticare Department of Medical Oncology and Infusion Services

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