Prevention of infection on the oncology unit.

Various combinations of immune deficiency, tumor effect, surgery, ionizing radiation, chemotherapy, and neutropenia result in infection-prone states for hospitalized cancer patients. Recognition of nosocomial infection may be difficult, and fever may be the only finding. Pathogens may be exogenously acquired from the contaminated hospital environment. Transmission by contact with hospital personnel is the usual mode of exogenous acquisition of hospital bacteria, and handwashing is the most effective means of prevention. The utility of conventional protective isolation in prevention of exogenous transmission is in question. Inattention to infection control measures by nurses and physicians may result in higher infection rates and more serious types of infections. Endogenous infection by the patient's own bacteria and fungi also occurs in the cancer ward. Autoinfection is "amplified" by the use of cannulae, catheters, and other hospital devices. Meticulous nursing care, particularly in neutropenic persons, is important in reducing the incidence of endogenous spread of microbes. Exogenous and endogenous infections in neutropenic patients are reduced using laminar air flow rooms combined with prophylactic antibiotics. It is still not clear if these expensive measures are effective in prolonging survival of patients with acute leukemia.