‘Empowered’ Nurses Cut Respiratory Infections in BMT Unit

WASHINGTON—For patients undergoing bone marrow transplant (BMT), viral respiratory infections can prove fatal. Viral respiratory infection was a contributing factor in two patient deaths during a 17-case viral respiratory outbreak among the staff, patients, and family members of a BMT unit, said Leslie D. Wehrlen, RN, BSN, OCN, clinical research nurse, Clinical Cancer Nursing Department, National Institutes of Health (NIH).

Soon after the outbreak, a multidis-ciplinary team of physicians, nurses, and pharmacists from the medical center’s BMT, infectious disease, occupational medicine, and epidemiology services began work on new infection control standards to prevent any recurrence of such an outbreak, she reported at the 27th Annual Congress of the Oncology Nursing Society (abstract 61).

Under the procedures in effect at the time of the 17-case outbreak, patients generally were placed in respiratory isolation only after a positive culture had established the presence of a viral infection. Patients and their families received only limited formal education on avoiding upper respiratory infections. Patients also sat in large waiting rooms that increased the risk of exposure.

The New Strategy

The new prevention strategy led to an immediate change in practice. Respiratory isolation now begins as soon as symptoms of infection appear. In addition, patients, family, and staff all receive intensive training on recognizing symptoms of respiratory infection, preventing their spread, and managing viral illnesses. Family members learn of the importance of not transmitting infections either at home or in the BMT unit.

Signs in both English and Spanish posted at the unit’s entrance warn visitors to be aware of viral symptoms and avoid visiting should any be present. In addition, steps were taken to obtain culture results more rapidly.

Staff are offered free flu vaccinations and instructions to monitor themselves carefully for symptoms. Should flu-like symptoms appear, the staff members may receive treatment with medicines such as oseltamivir phosphate (Tamiflu).

Staff with symptoms are encouraged to discuss the advisability of coming to work with the nurse manager and the occupation health service. Although staff members dislike calling in sick because of respiratory infections, they also "don’t want to be the one causing patients to die," Ms. Wehrlen said.

Initially instituted during the flu season, the new standard has become part of the unit’s "seamless and intuitive practice" year round, Ms. Wehrlen said, with nurses now empowered to invoke it when they first notice symptoms without waiting for physician approval. Physicians are then immediately notified.

Since the full plan has been in effect, hospitalizations and sequelae from upper respiratory symptoms have declined on the unit, and there have been no cases of respiratory infection transmission.

Co-authors of the abstract are Mi-chael Krumlauf, RN, BSN, and Margaret Bevans, RN, BSN, MS, AOCN, both with NIH.