Infectious Causes of Cancer: A Guide for Nurses and Healthcare Professionals

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Theatre staff are sometimes reluctant to remove their wedding rings when scrubbing up. Higher microbial counts after washing are found in health workers who prefer not to remove rings, 11 and may put the patient at risk for a nosocomial infection. In one study, subjects who washed with an antiseptic soap alone had a twofold greater reduction in bacterial counts than when they scrubbed with a brush.

Continued monitoring and educational efforts can improve hand washing habits. The importance of constantly reminding staff of the need for hand washing, and of senior staff setting a good example by their own hygienic practices, cannot be overemphasised. It is difficult to provide clear guidelines on how often hands should be washed.

The Handwashing Liaison Group is emphatic: The thoroughness of application is more important than the time spent on washing or the agent used. Gloves are a useful additional means of reducing nosocomial infection, but they supplement rather than replace hand washing. Possible microbial contamination of hands and transmission of infection has been reported despite gloves being worn. Sterile gloves are much more expensive than clean gloves and need only be used for certain procedures, such as when hands are going to make contact with normally sterile body areas or when inserting a central venous or urinary catheter.

Clean gloves can be used at all other times, including during wound dressings. For gloves to be used appropriately they must be readily available. Again, this is not always the case at many clinics and hospitals in poorer settings. Gowns help keep infectious materials off clothing, although in some centres they are used more as reminders that the patient is isolated.

Two recent studies confirm that staff gowning in the neonatal intensive care unit is an unnecessary custom. There was no change in traffic patterns in the unit or in hand washing behaviour, 18 and it was not cost-effective. It has never been shown that wearing surgical facemasks decreases postoperative wound infections. When originally introduced, the primary function of the surgical mask was to prevent the migration of microorganisms residing in the nose and mouth of members of the operating team to the open wound of the patient.

However, it is now recognised that most bacteria dispersed by talking and sneezing are harmless to wounds. The difference was not significant.

Infection Prevention in the Cancer Center

Thus while masks may be used to protect the operating team from drops of infected blood and from airborne infections, they have not been proven to protect the patient. Some health personnel have difficulty in accepting that the stethoscope, the symbol of their professional status, may actually be a vector of disease. There are no studies on the beneficial effect of regularly cleaning stethoscopes on nosocomial infection rates. Like the stethoscope, the white coat has long been a symbol of the medical professional.

Many institutions insist that junior doctors, in particular, wear a white coat as part of a mandatory dress code. About half of all patients still prefer their doctor to wear one. The recommendation that the coat is removed and a plastic apron is donned before wound examination is rarely followed in practice. While few would challenge the sartorial elegance of the white coat, clearly its value needs to be critically assessed.

There is little microbiological evidence for recommending changing white coats more often than once a week, or for excluding the wearing of white coats in non-clinical areas. The insertion of an intravenous needle or cannula results in a break in the body's natural defences. Organisms can enter the circulation from contaminated fluid or a giving set, or can grow along the outer surface of the cannula. Prevention of complications requires careful insertion practice and optimal catheter care.

Inserting a peripheral catheter demands the same precautions as for any surgical procedure. The hands should be disinfected with alcohol and gloves should be worn.

Cancer & Oncology Nursing NCLEX Practice Quiz #1

The insertion site should not be touched after disinfection. The use of a clear, adhesive, bacteria impermeable dressing to secure the cannula has become popular. These dressings may be contraindicated as they allow accumulation of blood, sweat, and exudate, which may promote growth on and in the underlying skin. Indeed, a meta-analysis showed a significantly increased risk of catheter tip infection when transparent rather than gauze dressings were used with either central or peripheral catheters.

Routine replacement of the intravenous line every three to five days is common practice in the USA but not in Europe. Guidelines developed by the Centers for Disease Control and Prevention recommend that peripheral intravenous catheters be changed every three days. However, routine replacement of central venous catheters was no longer supported in their latest update. Containers of intravenous fluids are usually changed before significant growth occurs, but the giving set does not need to be replaced more often than every 72 hours.

Practical methods for preventing nosocomial infection What's in. Methods for preventing nosocomial infections are summarised in box 2. Nosocomial infections are worth preventing in terms of benefits in morbidity, mortality, duration of hospital stay, and cost. Educational interventions promoting good hygiene and aseptic techniques have generally proved to be successful, but these practices are often not sustainable. Greater efforts are being made in some countries to ensure the application of the infection control evidence base into practice. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Skip to main content. We use cookies to improve our service and to tailor our content and advertising to you. More info You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our cookies policy. Log in via OpenAthens. Log in using your username and password For personal accounts OR managers of institutional accounts. Forgot your log in details? Register a new account? Forgot your user name or password? Search for this keyword. Log in via Institution. The health professional's role in preventing nosocomial infections.

Abstract Despite their best intentions, health professionals sometimes act as vectors of disease, disseminating new infections among their unsuspecting clients. Aetiology of nosocomial infections Intravascular device related infections and infections acquired through the respiratory tract are among the most common nosocomial infections in critically ill patients.

Risk factors for nosocomial infection Duration of hospital stay Indwelling catheters Mechanical ventilation Use of total parenteral nutrition Antibiotic usage Use of histamine H 2 receptor blockers owing to relative bacterial overgrowth Age—more common in neonates, infants, and the elderly Immune deficiency. Hand washing The hands of staff are the commonest vehicles by which microorganisms are transmitted between patients. The use of medications that affect incretin receptor signaling has been postulated to increase pancreatic cancer incidence, but neither animal nor clinical data which are limited support that claim at this time.

Many of the groundbreaking observational studies in cancer etiology date back to a time when widespread cancer screening did not occur.

Injection Safety

Given the extensive uptake of screening for certain cancers over the past quarter-century, recently conducted observational etiologic studies included participants whose disease was detected through screening. This is because overdiagnosed cases would never have been diagnosed in the absence of screening. For example, assume that blue eyes relative to brown eyes are associated with receiving prostate-specific antigen PSA screening or preference for diagnostic biopsy, but not with prostate cancer.

In the absence of screening, a null result would have been observed for the association of blue eyes and prostate cancer. In the presence of screening, blue eyes would be associated with prostate cancer, because blue eyes would lead to screening, and screening would detect overdiagnosed cases. Chemoprevention refers to the use of natural or synthetic compounds to interfere with early stages of carcinogenesis, before invasive cancer appears.

Finasteride an alpha-reductase inhibitor lowers the incidence of prostate cancer. Both of these effects may account for the finding that finasteride recipients have an absolute higher incidence of high-grade prostate cancer, i. COX-2 inhibitors inhibit the cyclooxygenase enzymes that are involved in the synthesis of proinflammatory prostaglandins. Evidence suggests that COX-2 inhibitors may prevent colon and breast cancer but concerns about cardiovascular risk preclude extensive study. A randomized controlled trial RCT of moderately high-dose celecoxib in patients with arthritis showed no difference in cardiovascular outcomes when compared with nonselective nonsteroidal anti-inflammatory agents NSAIDs.

Aspirin has been studied extensively as a chemopreventive agent. A significant side effect of aspirin is bleeding, which may preclude widespread use for cancer prevention. Because aspirin may help reduce death from cardiovascular disease which is responsible for more deaths than cancer , use of aspirin should be considered in a larger context of prevention beyond cancer.

Similarly, serious harms from bleeding from gastrointestinal tract or intracranial should be considered in light of patients' individual risks of specific harms. Some have advocated vitamin and mineral supplements for cancer prevention. Many different mechanistic pathways for anticancer effects have been invoked. A commonly tested hypothesis is that antioxidant vitamins may protect against cancer, based on the premise that oxidative damage to DNA leads to cancer progression.

Hence preventing oxidative DNA damage would prevent progression to cancer. However, the evidence is insufficient to support the use of multivitamin and mineral supplements or single vitamins or minerals to prevent cancer. Other unanticipated adverse events have been documented for dietary supplement use. Only calcium users were associated with a statistically significant reduction in mortality rates compared with nonusers.

Research into the potential anticancer properties of vitamin and mineral supplements is ongoing, and the results continue to reinforce the lack of efficacy of vitamin supplements in preventing cancer. The absolute increase in risk of prostate cancer with vitamin E use was 1. Selenium did not reduce the risk of prostate cancer HR, 1.

Vitamin D has also generated interest as a potential anti-cancer agent. Sources of vitamin D include cutaneous synthesis upon exposure to sunlight, dietary intake, and supplements. Evidence for the efficacy of vitamin D supplements with or without calcium in preventing cancer incidence is available as a secondary endpoint from randomized controlled trials, with a summary of the results from three trials providing evidence of lack of efficacy.

None of the randomized controlled trials mentioned above studied multivitamin supplements as commonly taken by the general U. In the PHS II, 14, male physicians were randomly assigned to receive either a daily multivitamin supplement or a placebo for a median of 11 years. The overall reduction in cancer risk was more pronounced in men who had been diagnosed with cancer before the study began HR, 0.

This puzzling result, along with the weak association and multiple statistical comparisons made for many different trial endpoints, diminishes the strength of evidence provided by the PHS II trial. The relationship between environmental pollutants and cancer risk has been of long-standing interest to researchers and the public.

When estimates of the potential burden of cancer have been calculated for different classes of exposure, the factors described earlier, such as cigarette smoking and infections, have represented much greater proportions of the cancer burden than have environmental pollutants. Nevertheless, some associations between environmental pollutants and cancer have been clearly established. Perhaps because the lung is most heavily exposed to air pollutants, many of the most firmly established examples of pollutants and cancer relate specifically to lung cancer, including secondhand tobacco smoke, indoor radon, outdoor air pollution, and asbestos for mesothelioma.

Another environmental pollutant linked with cancer is highly concentrated inorganic arsenic in drinking water, which is causally associated with cancers of the skin, bladder, and lung. Many other environmental pollutants, such as pesticides, have been assessed for risk with human cancer, but with indeterminate results. There are challenging methodological issues to address in these studies, such as accurately measuring exposures for long periods, which often make it difficult to clearly establish an association between an environmental pollutant and cancer. The list of topics considered above is not exhaustive.

Other lifestyle and environmental factors known to affect cancer risk either beneficially or detrimentally include certain sexual and reproductive practices, the use of exogenous estrogens, and certain occupational and chemical exposures. In this summary, factors were selected that appear to impact the risk of several types of cancer and that have been identified as being potentially modifiable. These include cigarette smoking, which has been conclusively linked with a wide range of malignancies; avoidance of cigarette smoking has been shown to reduce cancer incidence.

Other potential modifiable cancer risk factors include alcohol consumption and obesity; physical activity is inversely associated with the risk of certain cancers. More research is needed to determine whether these associations are causal and whether avoiding risk behaviors or increasing protective behaviors would actually reduce cancer incidence.

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above. Description of the Evidence.

Cancer Prevention Overview (PDQ®)—Health Professional Version - National Cancer Institute

Added text to state that the expectation is that, if a risk factor truly causes cancer, it would also be the case that a lifestyle modification i. Because observational studies rarely provide conclusive evidence of such relationships, additional evidence is required cited Song et al.

Added text to state that the risk of cancer-specific death after a solid organ transplant is higher during the first 6 months posttransplant but persists for many years; it is especially high for cancers linked to viral infections. Added text to state that a recent analysis of the long-running Nurses' Health Study and Health Professionals Follow-up Study estimated the proportions of cancer cases and deaths in the U. Also added text to state that one major weakness of the study was that its premise assumed the causality of the nonsmoking risk factors; the analysis was further weakened by using self-reported measures of diet and alcohol use, and by measuring only leisure-time physical activity.

Also, the authors did not present the effects of the nonsmoking risk factors after accounting for smoking; this analysis and others with similar weaknesses should therefore be interpreted cautiously cited Song et al. This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about cancer prevention.

It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions. Board members review recently published articles each month to determine whether an article should:. Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary. Any comments or questions about the summary content should be submitted to Cancer.

Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries. Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Screening and Prevention Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.

PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. Permission to use images outside the context of PDQ information must be obtained from the owner s and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online , a collection of over 2, scientific images. The information in these summaries should not be used as a basis for insurance reimbursement determinations.

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Carcinogenesis Carcinogenesis refers to an underlying etiologic pathway that leads to cancer. Risk Factors The promise for cancer prevention is derived from observational epidemiologic studies that show associations between modifiable lifestyle factors or environmental exposures and specific cancers. Radiation Radiation is energy in the form of high-speed particles or electromagnetic waves.

Immunosuppression after organ transplantation Medications that suppress the immune system in patients undergoing organ transplantation are associated with an increased cancer risk. Physical activity A growing body of epidemiologic evidence suggests that people who are more physically active have a lower risk of certain malignancies than those who are more sedentary.

Obesity Obesity is being increasingly recognized as an important cancer risk factor.