Dear OncoLink "Ask The Experts,"
Are there any standard protocols involving neutropenic precautions while in the hospital? Presently, at my hospital, they consider neutropenia a valid reason for isolation in leukemics only, and solid tumor patients with neutropenia can co-habit with another patient. I find this unsafe and I try to have all my neutropenic patients in private rooms. Are there any studies that show that neutropenic patients do not need to be separated while in the hospital? My unit also has med/surg patients along with oncology patients.
Katie Willey, MSN, Clinical Nurse Specialist at the Abramson Cancer Center of the University of Pennsylvania, responds:
Neutropenic precautions exist to prevent infection in all patients who are immunocompromised. Whether or not a patient is immunocompromised depends on his or her absolute neutrophil count, and is irrespective of diagnosis. It is not limited to a diagnosis of leukemia. However, there is great variance in the practice of neutropenic precautions from institution to institution. Currently, no studies exist to support isolating neutropenic patients in their own room as a means of preventing infection (Siegel et al., 2007; Zitella et al., 2006). However, experts believe that strict adherence to standard precautions and hand hygiene will reduce the spread of infectious pathogens (Duffy, 2009). There is agreement in the literature that further research is needed in this area to determine the efficacy of isolation for those who are neutropenic.
In weighing the risks and benefits, the Hospital of the University of Pennsylvania, does provide private rooms for all patients, who are neutropenic with an ANC of <1000, as well as for patients with highly communicable infections, such as Clostridium difficile (C-diff) and Vancomycin-resistant Enterococci (VRE). We also restrict our neutropenic patients from eating foods known to carry pathogens, such as fresh fruit and vegetables and soft cheeses, though research has yet to confirm any benefit to the neutropenic diet.
Duffy, L. (2009). Care of the immunocompromised patients in the hospital. Nursing Standard, 23, 35-41.
Siegel et al. (2007). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007. http://www.cdc.gov/ncidod/dhqp/gl_isolation.html
Zitella et al. (2006) Putting evidence into practice: prevention of infection. Clinical Journal of Oncology Nursing. 10, 6, 739-750.