Infection prevention aimed at cancer patients

Vulnerable population needs attention

Each year more than one million patients receive cancer treatment in an outpatient oncology clinic. Despite advances in oncology care, infections from community and healthcare settings remain a major cause of hospitalization and death among cancer patients receiving chemotherapy.

To help protect this vulnerable patient population, the Centers for Disease Control and Prevention (CDC) is launching a program featuring tools to help clinicians and patients prevent infections.

"Cancer patients receiving chemotherapy often have weak immune systems and need to be kept safe against germs," said CDC Director Thomas Frieden, MD, MPH.   "These new resources help patients take an active role in protecting themselves against infection and give doctors, nurses, and other clinicians necessary tools to better prevent infection."

CDC's Preventing Infections in Cancer Patients program is a comprehensive initiative focusing on providing information, action steps, and tools for patients, their families, and their healthcare providers to reduce the risk of life-threatening infections during chemotherapy treatment. These resources include an interactive web site (www.preventcancerinfections.org) for cancer patients and caregivers, as well as a Basic Infection Control and Prevention Plan for use by outpatient oncology settings. (http://www.cdc.gov/hicpac/basic-infection-control-prevention-plan-2011).

The new web site, named "3 Steps Toward Preventing Infections During Cancer Treatment," includes a questionnaire that helps cancer patients understand their risk for developing a condition called neutropenia, a low white blood cell count during chemotherapy. Neutropenia is a common and potentially dangerous side effect of chemotherapy that reduces a patient's ability to fight infection. Cancer patients and caregivers can answer a few questions about their risk factors and receive information about how they can prepare, prevent, and protect themselves from getting an infection during their cancer treatment:

Prepare: Watch out for a fever during chemotherapy.

Prevent: Clean your hands.

Protect: Know the signs and symptoms of an infection and what to do if you develop any signs or symptoms.  

For health care providers and facility administrators, The Basic Infection Control and Prevention Plan for Outpatient Oncology Settings includes key policies and procedures to ensure the facility meets or exceeds minimal expectations for patient safety, as described in the newly released "CDC Guide to Infection Prevention in Outpatient Settings." That guide is available at http://www.cdc.gov/HAI/settings/outpatient/outpatient-care-guidelines.html. The elements in this plan are based on CDC's evidence-based guidelines and those from professional societies.

Alice Guh, MD, medical officer and co-lead of the initiative at CDC, said, "Outpatient oncology facilities' attention to infection prevention varies greatly. Repeated outbreaks resulting from lapses in basic infection prevention practices, such as syringe reuse, have put patients at risk. In some of these cases, the implicated clinic did not have written infection control policies and procedures or regular access to infection prevention expertise."

It is critical that care of this vulnerable patient population be provided under conditions that minimize the risk of healthcare-associated infections, the CDC says. This responsibility should be shared by clinicians, to follow best practices and facility administrators, to ensure that staff has appropriate resources and training, the agency says. A combined approach will help to emphasize the importance of creating a culture of infection prevention at all healthcare facilities, it says.

The CDC recommends that outpatient oncology facilities use the plan in one of the following ways:

Facilities that have a plan in place should ensure that its policies and procedures include the elements outlined in this tool.

Facilities without a plan should use this resource as a tool to draft and implement a plan for their facility.

Facilities can use this plan as written or modify it with facility-specific information. 

"Preventing Infections in Cancer Patients" was developed by oncology and infection prevention experts from the CDC in partnership with external experts and the CDC Foundation. To access the plan, checklist, clinician and patient education materials and additional information, please visit http://www.cdc.gov/cancer/preventinfections.