These are patients whose chemotherapy makes them especially vulnerable to harsh consequences from infections, such as prolonged illness, neutropenia, delayed chemotherapy treatments to push back their cancer, hospitalizations, or even death.
The problem is seen as so critical, that the CDC this week released an 18-page Basic Infection Control and Prevention Plan for Outpatient Oncology Settings, a documentdesigned to give guidance to "all outpatient oncology facilities. It is directed "especially [at] those that don't have a written plan that includes infection control policies and procedures," which the CDC says many facilities now lack.
Guh says care practices have evolved this way because, "the way our healthcare system is right now, only hospital settings and certain types of outpatient settings (such as dialysis centers and ambulatory surgery centers) are routinely inspected."
Some states have regulatory programs to cover these types of facilities, but oversight is spotty and purviews vary. Outpatient facilities that operate under a physician's medical license also are not subject to the same regulatory review. "I think it's something that we all, as federal agencies, should try to work toward," says Guh.
Researchers and clinicians haven't been tuned into the problem because, Guh says, it only comes to light "if an astute clinician notices something, or a patient presents with an infection and after further investigation and interviews, someone realizes additional infections are cropping up and are all linked to the same cluster at the same facility."
The ramifications are severe. About 60,000 patients with cancer who have received chemotherapy are hospitalized with neutropenia in the United States each year.