Preventing Infections in Cancer Patients My Pocket Guide

Preventing Infections In Cancer Patients My Pocket Guide

A quick guide to CDC’s Basic Infection Control and Prevention Plan For Outpatient Oncology Settings And Patient Education Resources

National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion Healthcare Challenge As a healthcare provider, you know that patients receiving chemotherapy are at risk for developing infections that may lead to hospitalization, disruptions in chemotherapy schedules and, in some cases, death.

My Pocket Guide Tools and Intervention Strategy Preventing Infections in Cancer Patients is My Pocket Guide is your quick reference a comprehensive initiative, led by CDC and the CDC Foundation, to reduce infections by for protecting cancer patients and raising awareness among patients, caregiv- healthcare personnel from infections. ers, and healthcare providers about steps It was developed for outpatient they can take to protect themselves during oncology facilities as a quick reference chemotherapy treatment. guide to CDC’s Basic Infection Control and Prevention Plan for Outpatient Your Role Within Your Facility Oncology Settings. The full plan contains Be vigilant. policies and procedures to meet minimal If you suspect an infection in a patient, it is expectations of patient protections as your responsibility to report it to the appro- described in CDC’s Guide to Infection priate personnel so that proper diagnostic work-up and treatment can be provided to Prevention for Outpatient Settings. the patient. Maintaining vigilance for infections can also help detect outbreaks early.

Guide to Infection Prevention You have a responsibility. for Outpatient Settings is Every staff member has an important role in available at: preventing infections in cancer patients by www.cdc.gov/HAI/settings/ following Standard Precautions, which are outpatient/outpatient- the minimum infection prevention measures settings.html that apply to all patient care.

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Quick Guide Section Personal Protective The elements in the following Quick Equipment (PPE) Guide section are taken from CDC’s • PPE (e.g., gloves, gowns, facemasks) Basic Infection Control and Prevention should be worn if there is potential for Plan for Outpatient Oncology exposure to blood, body fluids (e.g., Settings, which is based on CDC’s respiratory secretions, wound drain- Personal Protective Equipment evidence-based guidelines and age), mucous membranes, nonintact skin or contaminated equipment. guidelines from professional societies. • Choose the type of PPE based on the anticipated nature of the patient inter- Hand Hygiene action and/or the likely mode(s) of transmission. • Alcohol-based hand rub is the pre- ferred method for decontaminating • Perform hand hygiene before and after your hands, except when hands are removing PPE. visibly soiled (e.g., dirt, blood, body • PPE should be removed before exiting fluids), or after caring for patients with the patient environment. Hand Hygiene known or suspected infectious diarrhea (e.g., Clostridium difficile, norovi- rus), in which case soap and water should be used.

• Perform hand hygiene before and after glove removal.

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Respiratory Hygiene Injection Safety/ Medication Handling • Identify and triage patients and visitors with respiratory symptoms upon entry to • Use aseptic technique* when prepar- the facility, especially during flu season. ing and administering chemotherapy or other parenteral medications. Injection Safety/Medication Handling • Know your facility’s sick leave policies. • Prepare parenteral medications as close as possible to the time of administration. • Healthcare personnel with a respiratory infection should avoid direct patient • Never administer medications from the contact; if this is not possible, then a same syringe to more than one patient, facemask should be worn while provid- even if the needle is changed. ing patient care and frequent hand hygiene should be performed. • After a syringe or needle has been used to enter or connect to a patient’s IV, it is • Institute measures to prevent spread of contaminated and should not be used on respiratory infections, including: another patient or to enter a medication vial. - Separating patients and using face • Do not administer medications from masks single-dose or single-use vials or bags or bottles of intravenous solution to - Ensuring availability of infection control more than one patient. supplies for patient and healthcare Respiratory Hygiene personnel use (e.g., alcohol-based hand • Assign medications packaged as rub dispensers, facemasks, tissues) multi-dose vials to a single patient whenever possible. • Wear a facemask when placing a catheter or injecting material into the epidural or subdural space.

* Aseptic technique is used by health care workers to prevent the contamination of clean areas, equipment, and sterile medications. This will help prevent the spread of infection. 6 7 QUICK GUIDE QUICK GUIDE

Central Venous Environmental Cleaning Catheter Access • Regularly perform environmental clean- • Use aseptic technique when accessing, focusing on high-touch surfaces ing patients’ central venous catheters. when cleaning patient-care areas, such This includes performing hand hygiene as patient chairs and IV poles in che- and ensuring an appropriate antisep- motherapy suites and exam tables in tic agent is properly applied prior to patient exam rooms.

accessing the catheter. Central venous Environmental Cleaning • Follow manufacturer’s instructions for catheters include: cleaning and disinfecting environmen- - Peripherally inserted central catheters tal surfaces and medical devices; en- (PICCs) sure that the cleaning product used is compatible with the surface or device - Tunneled catheters being cleaned. - Implanted ports Central Venous Catheter Access

My Pocket Guide is adapted from: Basic Infection Control and Prevention Plan for Outpatient Oncology Settings 2011. Atlanta, GA: US Department of Health and Human Services, CDC; 2011. Available at http:// www.cdc.gov/HAI/settings/outpatient/basic- infection-control-prevention-plan-2011/ 8 9 TALKING POINTS

1. As well as killing cancer cells, the chemotherapy you have been receiving kills the white blood cells in your body. You are at greater risk for developing an infection when your white blood cell count is low. This condition, called neutropenia, is common after receiving chemotherapy. 2. White blood cells are one of the body’s major defenses against infection. 3. For patients with neutropenia, an infection can become serious quickly. 4. During your chemotherapy treatment, I encourage you to learn the 3 steps toward preventing infections:

STEP 1. PREPARE: Treat a fever as an emer- gency, and call the office right away if you develop a fever….even after hours. STEP 2. PREVENT: Clean your hands, and Your Role With don’t be afraid to ask everyone around Your Patients you to clean their hands as well. STEP 3. PROTECT: Know the signs and Empower your patients. Ensure your symptoms of an infection and what to do if patients are armed with the right tools you develop any of these signs or symptoms. and information to protect themselves 5. Visit PreventCancerInfections.org: This against infections. Web site was developed for cancer pa- Use our Talking Points on the next page tients and caregivers. It features a short questionnaire and identifies your personal as a guide to help you empower and risk level for developing neutropenia and educate your patients. potentially life-threatening infections. It also offers information and action steps on how to protect yourself from infections. 10 11 Patient Education Notes Resources To help raise awareness about the importance of preventing infections in cancer patients, CDC developed the following resources:

Basic Infection Control and Prevention Plan for Outpatient Oncology Settings - document

Basic Infection Control And Prevention Plan for developed for outpatient oncol- Outpatient Oncology Settings ogy facilities to serve as a model for an infection control plan. National Center for Emerging and Zoonotic Infectious Diseases

Division of Healthcare Quality Promotion

PreventCancerInfections.org - an evidence-based, interac- tive web site designed to help assess a cancer patient’s risk for developing neutropenia and subsequent infections.

WHAT YOU CANCERNEED IS TO KNOW A FIGHT. DON’T LET THE FLU KNOCK YOU DOWN. NEUTROPENIA AND RISK FOR INFECTION

WHAT IS NEUTROPENIA? Neutropenia, pronounced noo-troh-PEE-nee-uh, is a decrease in the number of white blood cells. These cells are the body’s main defense against infection. Neutropenia is common after receiving chemotherapy and increases your risk for infections.

Why does chemotherapy cause neutropenia? These cancer-fighting drugs work by killing fast-growing cells in the body—both good and bad. These drugs kill cancer cells Educational resources - as well as healthy white blood cells.

How do I know if I have neutropenia? Your doctor or nurse will tell you. Because neutropenia is common after receiving chemotherapy, your doctor may draw some blood to look for neutropenia. including fact sheets, When will I be most likely to have neutropenia? Neutropenia often occurs between 7 and 12 days after you receive chemotherapy. This period can be different depending FIGHT BACK!upon the chemotherapy you get. Your doctor or nurse will let you know exactly when your white blood cell count is likely to be at its lowest. You should carefully watch for signs and GET YOUR FLU SHOTsymptoms of infection during this time. posters, infographics Take action to protect yourself against the flu, so you can focus on the fight that matters Howmost. can I prevent neutropenia? There is not much you can do to prevent neutropenia from occurring, but you can decrease your risk for getting an The flu is serious for people who have cancer. infection while your white blood cell count is low. Give flu the one-two punch this season: 1. Get the flu shot—not the nasal spray vaccine. and more. 2. Make sure the people you live with or who care for you get the flu shot too. National Center for Chronic Disease Prevention and Health Promotion A flu shot is your bestDivision protection of Cancer Prevention andLearn Control more at: www.cdc.gov/ against the flu this season. cancer/preventinfections

National Center for Chronic Disease Prevention and Health Promotion

Division of Cancer Prevention and Control

This program was made possible through a CDC Foundation partnership with, and funding from, Amgen. As part of the partnership, the CDC Foundation considered oncology expertise provided by Amgen.

To learn more about these resources, please visit PreventCancerInfections. org/content/program-materials. Many of the materials listed above may be downloaded, copied or distributed without alteration or ordered free of charge. 12 13 Preventing Infections in Cancer Patients content was developed by CDC. Amgen provided its oncology expertise to the CDC Foundation which CDC considered in the development of these resources. This program was made possible through a CDC Foundation partnership with, and funding from, Amgen.