Assessment of Infection Prevention and Control Measures in Pediatric Hematology Oncology Unit, Ain Shams University

Abstract Background There are various factors which contribute to the increased susceptibility to infections in Pediatric Hematology/Oncology (PHO) patients, most prominent of them being disruption of cutaneous and mucosal barriers (oral, gastrointestinal, etc.), microbial gastrointestinal translocation, defects in cell-mediated immunity, and insufficient quantities and inadequate function of phagocytes. Aim of the Work This study aimed to assess the currently applied infection prevention and control (IPC) measures among Pediatric Oncology and Hematology patients admitted to the inpatient unit and to explore areas of improvement of IPC measures to improve the overall outcome of such patients. Patients and Methods This cross-sectional observational study was conducted at the Hematology and Oncology unit, Children's Hospital at Ain Shams University from April 2023 to September 2023. It assessed the IPC measures in the inpatient ward and the measures applied to the 100 admitted, patients in addition to reported infectious complications. The study also assessed the practices and vaccination status of the health care professionals(HCP). Results A total of 100 patients were included, hematological (including lymphomas)malignancies dominated with 72%, solid and CNS tumors represented 20% and the aplastic anemia patients represented 8%. The majority were admitted 77% for chemotherapy. Thirty-one febrile neutropenia episodes were reported. As regards the patient care practices, all patients followed a neutropenic diet as per hospital policy, no guidelines were available for drinking water, tap water was supplied through hospital tanks. Oral and dental care was strictly followed in 36% of patients during admission and only 2% had pre-chemotherapy dental assessment. Regarding other IP measures, strict guidelines were followed during central lines, venous access or indwelling catheter application. HCP vaccination status was defective in annual flu vaccine, however all were fully vaccinated with hepatitis B and COVID vaccines. Mucositis was reported in 45 % and was significantly correlated with sepsis-related mortality. Among the laboratory confirmed bloodstream infection (LCBI) staphylococcus aureus and staph coagulase negative dominated while in the reported central line- associated bloodstream infection (CLABSI)(15%), klebsiella was the commonest organism. Conclusion Staphylococcal infection and klebsiella were the commonest pathogens in the PHO ward. Though strict sterile measures were followed, still Staph coagulase was a common pathogen in CLABSI. Mucositis andmucosal barrier injury (MBI) is a significant risk for microbial translocation and morbidity. Dental care, water supply and healthcare professionals’ immunizations are important areas to improve in order to improve the PHO ward.