COMMENTARY

Protect Outpatient Oncology Patients From Infections

Alice Guh, MD, MPH

Disclosures

October 25, 2011

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Hello, my name is Alice Guh, and I'm an infectious disease physician and medical officer in the Division of Healthcare Quality and Promotion at the Centers for Disease Control and Prevention (CDC). I'm pleased to speak with you today as part of the CDC Expert Commentary Series on Medscape about a new Basic Infection Control and Prevention Plan for Outpatient Oncology Settings just released by the CDC.

As clinicians, we know that patients receiving chemotherapy are at risk for serious infections that may lead to hospitalization, disruptions in chemotherapy schedules, and in some cases, death. Each year more than 1 million cancer patients receive outpatient chemotherapy, radiation therapy, or both.[1] However, outpatient oncology facilities may vary greatly in their attention to infection prevention. For example, in an oncology clinic in Nebraska, it was discovered that syringes were reused to access bags of saline that were shared among multiple patients. This unsafe practice led to the transmission of hepatitis C virus to at least 99 cancer patients, resulting in one of the largest healthcare-associated outbreaks of its kind.

Unfortunately, lapses in basic infection control in oncology clinics have also resulted in a number of outbreaks of bacterial bloodstream infections such as the one that prompted the recent closure of a clinic in Mississippi. Often, these facilities did not have written infection control policies and procedures for patient protection. CDC has worked with partners to put together a basic infection control and prevention plan that can be used by outpatient oncology facilities to standardize -- and improve -- infection prevention practices.

CDC's new Basic Infection Control and Prevention Plan for Outpatient Oncology Settings 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. The key components include the following:

  • A brief review of what constitutes essential infection prevention, such as standard precautions and transmission-based precautions;

  • References and links to CDC's Outpatient Infection Prevention Checklist, CDC guidelines, and source documents; and

  • Key policies and procedures needed to meet minimal expectations for patient safety in an outpatient oncology setting. Some of these elements are:

    • Using aseptic technique to access patients' ports and adhering to safe injection practices when preparing and administering medications, including saline flushes and chemotherapy infusions;

    • Focusing on high-touch surfaces when cleaning patient-care areas, such as patient chairs and intravenous poles in chemotherapy suites and exam tables in patient exam rooms; and

    • Practicing good hand hygiene, respiratory hygiene/cough etiquette, and triaging of patients upon entry to the facility, especially during periods of increased community respiratory virus activity.

Oncology facilities that already have an infection control plan in place should use this plan to ensure that their policies and procedures include the essential elements. Although this plan may essentially be used exactly "as is," facilities may also choose to personalize it by adding the facility name and names of specific rooms, inserting titles or positions of designated personnel, and providing more detailed instructions where applicable.

All healthcare settings, regardless of the level of care provided, must make infection prevention a priority. We at CDC hope that this plan will help achieve this goal for oncology settings. We urge outpatient oncology providers to use this plan to ensure that cancer patients are receiving the safe care that they expect and deserve.

To review the complete Basic Infection Control and Prevention Plan for Outpatient Oncology Settings, follow the link or see the resources on this page.

Web Resources

Basic Infection Control and Prevention Plan for Outpatient Oncology Settings

CDC Healthcare-associated Infections: Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care

CDC Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care

Alice Guh, MD, MPH , is a medical officer in the Division of Healthcare Quality Promotion (DHQP) at the Centers for Disease Control and Prevention (CDC). She received a BA from Columbia University and obtained a dual degree in medicine and masters of public health at New York Medical College. She completed her internal medicine residency at Georgetown University Hospital and her infectious disease fellowship at Albert Einstein College of Medicine Montefiore Medical Center in Bronx, NY. Dr. Guh is board certified in internal medicine and infectious diseases. Prior to coming to DHQP, she served as the Epidemic Intelligence Service Officer for CDC at the Connecticut State Department of Public Health. In that capacity, she conducted epidemiologic studies of community- and healthcare-associated infections and performed outbreak investigations. Currently, Dr. Guh works on the ambulatory and long-term care team at DHQP. Her professional responsibilities include the promotion of safe injection practices; providing technical expertise in investigations of healthcare-associated outbreaks, particularly in outpatient settings; and working with state and local health departments to improve public health response to emerging multidrug-resistant organisms. One of her areas of interest focuses on the prevention of healthcare-associated infections in patients with cancer.

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