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Managing respiratory infections in oncology patients

Photo: Managing respiratory infections in oncology patients
An infection is a result of the immune system being unable to fight off harmful bacteria, viruses, and other microorganisms. Patients with cancer are more likely to get infections because their immune systems are compromised as a result of cancer treatments such as chemotherapy or radiation therapy.

Unfortunately, cancer patients also tend to suffer from less sleep, a poorer diet, and other traumatic side effects, all of which lead to a weakened immune system and a drop in white blood cell count. Although medical staff aim to check the white blood cell count regularly during chemotherapy, if the count drops it will usually occur one to two weeks after treatment. However, some infections can be managed through prescription of antibiotics (1).

Infections have become a major cause of morbidity in cancer patients, therefore it is essential to immediately manage them with the correct care and attention before the infection spreads and becomes fatal.
Respiratory infections and how they can be passed on

A respiratory infection can affect any of the sinuses, throat airway, or lungs. Respiratory infections can be transmitted via respiratory droplets or fomites, usually through direct contact. The following respiratory viruses can be transmitted through large particle droplets which are the result of sneezes or coughs by someone who is infected (2);

  • Influenza
  • Parainfluenza
  • Respiratory Syncytial Virus (RSV)
  • Adenovirus
  • Human Metapneumonovirus
  • Bordatella Pertussis

Each of these viruses require a close contact between someone who is infected and a recipient. Large droplets cannot remain suspended in the air; generally speaking they can only travel a short distance (less than one metre). However some viruses, such as the RSV virus, are able to survive on surfaces and hands for several hours (2).

Managing cancer patients with respiratory disorders in a hospital setting

Cancer patients who have been diagnosed with, or are suspected of, having a respiratory infection should be managed in isolation in their own room. These particular patients should be kept away from other patients who have high risk of complications, in order to reduce the infection’s chances of spreading. Such patients include oncology and haematology patients, congenital cyanotic heart disease patients, chronic respiratory illness patients, and those with congenital or acquired immunodeficiency and neonates (2).

Patients who have been diagnosed with respiratory infections and are immunosuppressed can shed the virus for extra-long periods of time. Hence why it is advised that patient to patient contact should be avoided as this can act as a reservoir for infection transmissions. However guidelines do suggest that patients who are asymptomatic and do not have a low white blood cell count can be kept with non-immunocompromised patients as long as the right precautions in terms of contact are maintained.

Visitors should also be advised about the strict hand hygiene rules when visiting admitted patients in order to reduce the risk of spreading infection. They should also aim to limit contact with other visitors of symptomatic respiratory infections. Any visitor who is showing signs of a symptomatic respiratory infection should wear a mask to limit risk of particle droplets forming. Guidelines also suggest that respiratory viral testing specimens do not need to be performed more than once every seven days.

In order to avoid any infections in hospitals and healthcare facilities, healthcare staff are advised to take contact precautions. This includes wearing gowns and adhering to strict hand hygiene procedures for the duration of the respiratory illness. Precautions should also be in place where infections can be transmitted via particle droplets. These precautions include wearing a mask during any procedure which could generate aerosols (such as suctioning, chest physiotherapy and so forth)(2).

Other tips to manage cancer patients with respiratory disorders

Cancer patients who are at higher risk of contracting infections due to a low white blood cell count can be prescribed medication known as white blood cell growth factors. These drugs assist the body in making more white blood cells to reduce the chances of the patient becoming vulnerable to contracting infections (3).

Patients should be advised to take the following steps alongside any medication for their own optimal health and benefit (3);

  • Eat a well-balanced diet, as well as getting plenty of sleep and rest
  • Avoid contact with anyone who has an infection
  • Not to share food, utensils, cutlery or other personal items
  • Follow optimal hand hygiene rules; wash hands thoroughly before eating, after using the toilet, and wearing gloves when undertaking any gardening or cleaning during housework
  • Avoid raw foods in case of food being undercooked and infected

Sources:

Cancer Australia
The Royal Children's Hospital Melbourne
Cancer.Net


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