Evidence-based nursing practice to prevent infection in hospitalized neutropenic patients with cancer.
OBJECTIVE
To review studies that have assessed the effectiveness of selected nursing interventions used in hospitals to prevent healthcare-associated infections in neutropenic patients with cancer.


METHODS
Literature review of low microbial diets, protective clothing and environments, personal hygiene, and oral care in English-language articles from PubMed; the Cumulative Index of Nursing and Allied Health Literature; the National Guideline Clearinghouse, 1980-June 2003; and Cochrane Database of Systematic Reviews.


RESULTS
Few studies have demonstrated the effectiveness of low microbial food and water and protective environments and clothing in reducing infections in neutropenic patients with cancer, and hospitals vary in these practices. Skin antisepsis reduces microbial counts, but data regarding the effect on infections are lacking. Many studies were characterized by insufficient sample sizes or use of multiple interventions.


CONCLUSIONS
Major gaps exist in empirical evidence regarding which nursing interventions might be helpful in preventing or controlling healthcare-associated infections in neutropenic patients.


CONCLUSIONS
Although the evidence base for clinical practices such as a low microbial diet, protective environments and clothing, and special skin antisepsis regimens is weak, some of these practices seem prudent and reasonable. Until further evidence is available, clinicians can use consensus guidelines and should assist in identifying clinical practices that require additional research. Ultimately, interventions with little or no demonstrated efficacy should be examined systematically or abandoned. Additional studies of sufficient sample size regarding nursing practices such as the role of protective environments, room placement, antiseptic bathing, and prevention and treatment of oral complications are indicated. Because of difficulties in randomization and risk stratification, rigorous observational studies often may be an acceptable alternative to clinical trials.
Larson
Elaine
E
School of Nursing, Columbia University in New York, NY, USA. ell23@columbia.edu.
Nirenberg
Anita
A
D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D000970:Antineoplastic Agents / Q000009:adverse effects; D001494:Baths; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D004866:Equipment Contamination; D019317:Evidence-Based Medicine; D005516:Food Microbiology; D006801:Humans; D006920:Hygiene; D017053:Infection Control / Q000379:methods*; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy / Q000451:nursing*; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications / Q000451:nursing*; D009910:Oral Hygiene; D010356:Patient Isolation; D010362:Patients' Rooms; D011481:Protective Clothing; D018401:Sample Size; D017592:Skin Care; D014871:Water Microbiology
D000891:Anti-Infective Agents, Local; D000970:Antineoplastic Agents