Q 4Q 4
Reducing Exposure of Patients with Neutropenia to Fungal Pathogens
What factors reduce the exposure of a patient with neutropenia to fungal pathogens?
Fungal infections are a major factor associated with mortality and morbidity in patients with cancer who develop neutropenia. Quality of life is severely affected by the symptoms and stress associated with cancer-related fungal invasions. Preventing fungal infection is a priority in the care of both hospitalized and ambulatory cancer patients.
Lessening the exposure to fungal pathogens is one method for decreasing the occurrence of infection in patients both in the hospital and in the community. Nursing professionals must examine environmental factors that may place these patients at risk for infections.
Although the overall incidence of invasive fungal infections may be relatively low, the cost in terms of treatment, length of stay, and mortality rates is high (des Champs-Bro et al., 2011). Treatment with antifungal drugs has been effective, but with antifungals used prophylactically, there has been a rise in unusual and drug-resistant strains such as non -albicans types of Candida and mn-Aspergillus species. Early diagnosis and treatment of fungal infections is crucial, but the prophylactic or empiric use of antifungals is still controversial with concerns about the rise of resistant strains, especially as broad-spectrum antifungal drugs such as posaconazole are used (Auberger etal., 2012). Empiric therapy is recommended for patients with neutropenia who have continued fevers not relieved by other drug treatment because the symptoms are often due to occult fungal infection. In these cases empiric antifungal drug therapy may be lifesaving.
Preventing an infection before it begins is the ideal clinical strategy. Infection control measures such as frequent and thorough hand washing, the use of disposable gowns and supplies, and thorough decontamination of the patient environment help to reduce the chance of transmission of fungi, molds, and spores (Gould, 2011). In addition, other factors that may reduce the patient's exposure to fungal pathogens include:
• Utilize strict aseptic technique when performing all invasive procedures, especially when inserting a urinary catheter or performing endotracheal suctioning, because these procedures are done in areas where fungal infections are common.
• Modify the environment to minimize airborne contamination. Negative airflow with HEPA filtration significantly reduces the risk of airborne spores, and appropriate housekeeping measures keep down dust.
• Eliminate potentially contaminated reservoirs such as soil, damp or moist fabrics, dried or fresh flowers, and standing water when possible.
• Keep patients who are neutropenic away from construction areas in the health care agency. This prevents transmission of airborne spores released during the construction process. Areas of construction should be sealed off with appropriate impermeable barriers.
• Provide high-filtration masks if patients must leave their rooms for procedures to minimize inhalation risk.
Because invasive fungal infections often occur in the lungs (Auberger et al., 2012), thorough assessment of the respiratory system should occur during each physical assessment of the patient. Patients who are neutropenic may exhibit subtle signs of infection, such as low-grade fever and fatigue, even when an infection is present. Frequent respiratory assessments will assist the nurse in noting these subtle changes over time.
Critical Thinking Question
Why are patients with neutropenia more susceptible to opportunistic infections such as fungal infections?