Baden, L.R., Swaminathan, S., Angarone, M., Blouin, G., Camins, B.C., Casper, C., . . . Smith, C. (2016). Prevention and treatment of cancer-related infections, version 2.2016. Journal of the National Comprehensive Cancer Network, 14, 882–913. Retrieved from http://www.jnccn.org/content/14/7/882.full.pdf

Purpose & Patient Population

PURPOSE: To examine the portion of the guidelines highlighting sections on antifungal and antiviral prophylaxis
 
TYPES OF PATIENTS ADDRESSED: Patients with cancer who become severely immunosuppressed following treatment

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline

PROCESS OF DEVELOPMENT: Information taken from a main document on NCCN.org (specifics not noted in this highlighted article), comprehensive literature search by panel members, evaluation and determination of best practices based on the evidence
 
DATABASES USED: PubMed
 
INCLUSION CRITERIA: Studies published from 2013 to 2015; English; clinical trials of patients in phases II, III, and IV; guidelines and meta-analyses; randomized, controlled trials and validation studies

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results Provided in the Reference

An initial search resulted in 1,162 citations, which were delimited to 277 references that contributed to these guidelines. High-level evidence findings were included as well as a review of lower-level evidence by panel members in areas where high-level evidence was lacking.

Guidelines & Recommendations

Algorithms were established for the use of antifungal and antiviral therapies and the use of vaccinations, specifically therapeutic drug monitoring of azoles; enhanced recommendations for HBV, HCV, and HIV; and vaccination utilization (outlined by disease/therapies and level of risk, p. 884–890). Overall, infection control should include prophylactic anti-infective therapies, per protocol per case, as well as ensure standards of care (e.g., hand hygiene). Considerations for susceptibility and resistance are paramount.

Limitations

  • No major limitations were noted. These werecomprehensive guidelines from a national work group.

Nursing Implications

Assessment of patient diagnosis, treatment, and preexisting comorbidities (e.g., HSV, HIV, CMV) can guide proper prophylactic anti-infective agents and vaccines. Together with following standards of practice (e.g., hand hygiene), nurses can optimize infection control.