Care Guide: Preventing Infections

Cancer and its treatment reduce the immune system’s power to fight infection. The patient will have an increased risk of infection for the duration of therapy. Steps can be taken to reduce the risk of infection. Most of these steps follow common sense rules of good hygiene.

Frequent Hand Washing Is Most Effective

• Wash hands with warm soapy water for at least 15 seconds
• The patient’s hands should be washed before meals, after using the bathroom, after blowing the nose and throwing away the tissue, and after playing with children
• Wash hands before touching the patient

When Blood Counts are Low

Keep kids and adults who do not live with the patient and who have signs of infection (such as fever, severe cough, sneezes, sore throat or a rash) away from the patient. If people with these symptoms must be around the patient, they should limit their time, wear a mask and practice good hand washing.

The patient should still go to school unless directed otherwise by your physician. Most of the minor illnesses in the school environment do not create a significant risk.

If household members are sick, we do not usually recommend keeping them away from the patient. Use common sense to prevent the spread of infection among household members:

• Always wash your hands frequently
• Do not drink from other household members’ cups
• Do not use the same eating utensils
• Do not eat from other household members’ dishes

Contact your treatment team immediately if household members are suspected to have or are diagnosed with chicken pox, shingles, measles or mumps.

If the patient has a central line, venous port or PICC line, follow instructions carefully for dressing changes and line care. Always wash your hands before handling the line. Refer to your central line book for specifics.

Contact your treatment team immediately if the patient has signs of infection. Keep a close eye on the patient’s mouth, rectal area, biopsy or surgical sites, and areas of injury (e.g., cuts in the skin, burns or rash). Watch for redness, fluid drainage, heat or an unusual degree of pain at the site of a wound.

Do not leave band-aids or bandages in place for more than 24 hours, unless you are instructed by the treatment team to do so.

Even when reasonable steps are taken ahead of time, the patient may still develop fevers or infections. If fever or infection develops, contact the treatment team immediately for further instructions.

Viral Infections

Viruses usually cause relatively minor infections, such as the common cold, but certain viruses can cause serious infections. Because the source of infection is difficult to find in patients receiving cancer treatment, those with low blood counts and signs of infection will be treated with antibiotics if a virus is suspected.

If the patient develops any rash, talk with your treatment team immediately. A rash may be caused by a serious infection, chicken pox or shingles. Do not bring the patient to the medical center if they have a rash unless the doctor or nurse tells you to do so.

Pain

Patients may experience pain during treatment. Some causes of pain may be:

Cancer-Related Pain

• Bone pain
• Pain at the tumor site

Treatment-Related Pain

• Bone pain
• Headaches
• Mouth sores
• Upset stomach

Procedure-Related Pain

• IV insertion
• Blood tests
• Surgery
• Lumbar puncture/spinal tap
• Bone marrow aspirate/biopsy
• Anticipatory pain before the procedure starts
• Recall of pain from previous experiences

Infection-Related Pain

• Abdominal pain
• Earache
• Headaches
• Stiff neck
• Wounds that do not heal

Pain can be managed using medications, distraction, music, massage, role-playing, relaxation and art therapy. The treatment team will work with patients and caregivers to develop the best pain relief plan.

Avoid pain medicines that contain aspirin and ibuprofen (unless directed by your health care team), as they may increase bleeding problems and irritate the stomach. You should call the treatment team before giving the patient any medicines not ordered by the doctor or previously discussed.

If the patient has severe pain, pain that persists, or pain and fever at the same time, please call the treatment team for further instructions.

A severe headache during times of low platelet counts or a stiff neck accompanied by fever should be reported to the treatment team immediately.

Body Image Changes

Patients will experience changes in physical appearance due to the side effects of cancer treatment. Expected side effects of treatment include:

Hair Loss

• Patterns of hair loss differ with each patient
• Hair loss is usually gradual over several weeks, beginning with thinning
• Hair will eventually re-grow after treatment is complete
• New hair may be lighter, darker or finer than before
• Keep bare heads covered in winter and summer to prevent sunburn and heat loss
• School-aged patients will be permitted to wear scarves or hats in school

Weight Gain

• If treatment includes steroids (e.g., prednisone or dexamethasone), the patient will likely experience weight gain
• Appetite may increase
• The patient may retain fluids, resulting in rounded face or belly
• Avoiding salty foods may help decrease fluid retention
• Mood changes may also occur

Weight Loss

• Appetite loss is common during cancer treatment
• The patient’s weight and nutritional status will be monitored during therapy
• Extra nutrition will be provided if necessary
• Discuss any nutritional concerns with your treatment team

Skin Changes

Cancer treatment can cause changes in skin color. Please call if the patient has:

• Increased bruising or small red dots which appear under the skin
• Any unusual rash
• Irritation or redness of the skin on any part of the body

Other Side Effects

Previously listed side effects are the ones which occur most commonly in treatment. Other side effects are possible. Your treatment team will discuss other potential side effects of specific medications with you before treatment.