Infection represents a leading cause of death and treatment-related toxicities among patients with cancer in the United States. It stands to interfere with antineoplastic treatment plans by forcing dose modifications, delays, or discontinuation and instead turning to a less aggressive treatment plan.
Sepsis—the immune system’s response to an infection—results in more than 200,000 in-hospital deaths each year. Risk factors include immunosuppression, recent hospitalization, presence of indwelling catheters and devices, malnutrition, and being elderly. Consideration of the risk factors for sepsis presents a challenge for our patient population, and oncology nurses surmount difficult odds in overcoming myelosuppression and atypical signs to identify infection and impending sepsis.
When exposed to foreign pathogens, inflammatory mediators induce a cascade of responses including endothelium damage, vascular permeability, microvascular dysfunction, coagulation pathway activation, and impaired tissue oxygenation. Some early indicators of sepsis are fever, tachycardia, tachypnea, and leukocytosis/leukopenia. Hypotension indicates tissue is already under perfused and sepsis is more advanced. Early sepsis recognition and implementation of early goal-directed therapy (EGDT) represents the most promise for preventing sepsis-related morbidity and mortality. Management requires aggressive, interdisciplinary care, and timely communication of patient status and response to treatment.
- Oxygen supplementation and respiratory stabilization
- Fluid Resuscitation
- Early antibiotic therapy (within one hour of suspected sepsis)
Vasopressors become necessary if fluids are inadequate in maintaining mean arterial pressure and organ perfusion. Additional considerations based on patient presentation are blood transfusions and insulin therapy.
ONS recently partnered with the American Nurses Association and Centers for Disease Control and Prevention (CDC) to offer additional infection prevention resources. ONS staff are working with these organizations to produce content regarding infection prevention and control strategies. Archived webinars produced by the CDC related to sepsis identification and management as well as preventing catastrophic infections in low resources countries are available and provide continuing education credits.