ONS’s evidence-based practice recommendations provide strategies (https://doi.org/10.1188/18.CJON.157-168) for practitioners to use in patients who are at increased risk for infection, particularly those receiving hematopoietic cell transplantation. Patients who are receiving systemic treatments should be evaluated for infection risk before each treatment. Organizations should support that work via documentation that makes timely and consistent evaluations that allow for comparison over time. Nurses should provide patient education on the symptoms of infection (https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/infections/preventing-infections-in-people-with-cancer.html), especially for those with neutropenia, and the importance of reporting them promptly:

• Fever
• Redness, tenderness, swelling, or yellowish discharge, especially at needle or catheter sites
• Cough or dyspnea
• Abdominal pain
• Rigors or diaphoresis
• Dysuria
• Pharyngitis, swollen lymph nodes, or mouth sores

General Infection Prevention

The following general infection prevention recommendations (https://www.cdc.gov/HAI/settings/outpatient/basic-infection-control-prevention-plan-2011) apply to all settings:

• Use hand hygiene, gloves, and masks in all patient interaction and practice respiratory hygiene and cough etiquette. Other personal protective equipment (e.g., gowns, face shields, double masking) depends on individual circumstances, patient population, and setting. Refer to the ONS infection recommendations for oncology-specific strategies.
• Regularly disinfect and sterilize surfaces and equipment.
• In patients with resistant organisms, follow contact precautions, including donning a gown and gloves to enter the room, patient isolation, and proper disposal of equipment. Use air filtration and positive air pressure rooms as well as protection from body fluids.
• Prohibit plants and dried or fresh flowers in the rooms of hospitalized neutropenic patients (https://doi.org/10.1093/cid/ciq147).
• Although low-microbial diets (prohibiting fresh fruit and vegetables and unprocessed food) are often recommended, studies have not shown that they decrease in infection. Standard food safety practices (https://doi.org/10.1200/JCO.2008.16.4681) that emphasize (https://doi.org/10.1097/01.mph.0000210412.33630.fb) safe handling and washing or thoroughly cooking food are appropriate.
• Patients are particularly at risk for central venous catheter infection. ONS recommends (https://doi.org/10.1188/18.CJON.157-168):
• Require proper hand hygiene for anyone entering a patient’s room during central line insertion or access.
• Scrub the site with 2% chlorhexidine for 30 seconds and allow to dry for at least 30 seconds before inserting or accessing a central line.
• Avoid frequent IV or dressing changes and the use of topical antibiotics.
• Change transparent dressings on long-term lines every seven days or more often if the patient exhibits any signs of infection such as diaphoresis, unexplained fever, oozing at the site, or signs that the dressing site is damp, loosened, or soiled. Palpate intact dressings on a regular basis to observe for tenderness.