Oncol Nurs Forum. 2015 Jan;42(1):74-9. doi: 10.1188/15.ONF.74-79.

Community respiratory virus infection in hematopoietic stem cell transplantation recipients and household member characteristics.

Sams KA1, Reich RR2, Boyington AR3, Barilec EM3.
  • 1Moffitt Cancer Center and Research Institute (MCCRI), Tampa, FL.
  • 2Department of Psychology, University of South Florida Sarasota-Manatee.
  • 3MCCRI.

 

Abstract

PURPOSE/OBJECTIVES: To determine if children or the number of contacts living in an immediate household increases the risk of community respiratory virus (CRV) acquisition in hematopoietic stem cell transplantation (HSCT) recipients.

DESIGN: Retrospective, exploratory study.

SETTING: National Cancer Institute-designated comprehensive cancer center located in the Southeast.

SAMPLE: 720 adult outpatients post-autologous or allogeneic HSCT.

METHODS: Data were gathered using a retrospective medical record review from July 1, 2006, to December 31, 2009. Summary statistics were used to describe sample characteristics. Binary logistic regression was used to determine whether the number of household member contacts or number of children in each age group was a significant predictor of CRV infection. Multivariate linear regression was used to investigate predictors of the number of CRV infections.

MAIN RESEARCH VARIABLES: The dependent variable was acquisition of CRV infection. Independent variables included the number of children in the household and the number of household members.

FINDINGS: Across all HSCT recipients, children aged 0-4 years (p = 0.01) and 5-12 years (p = 0.001) predicted CRV infection. The allogeneic group had the greatest incidence of CRV infection and was most sensitive to the presence of young children. The total number of household members was not a predictor of CRV infection.

CONCLUSIONS: Households with children aged 12 years and younger more than doubled the risk of an HSCT recipient acquiring CRV infection. Additional studies are needed to test interventions designed to interrupt household transmission of CRV infection from children to vulnerable HSCT recipients.

IMPLICATIONS FOR NURSING: Household contacts, particularly children, should be included in HSCT teaching. As indicated by the potentially high number of days from transplantation to acquisition of CRV infection, re-education and continuing focus on prevention of CRV infection should be reinforced throughout the lengthy transplantation period.

KEYWORDS: community respiratory virus; hematopoietic stem cell transplantation

PMID: 25542323

 

 

Supplement:

Community-acquired respiratory virus infections (CRV) are a threat to hematopoietic stem cell transplant (HSCT) outpatients. These infections may be responsible for unscheduled re-admissions, lengthy treatments, increased medical costs and mortality. Many variables and their relationship to CRV have been studied but, only outpatient status and age of the patient were identified as risk factors.

The presence of CRV infections and their spread in non-HSCT households has been associated with the presence of secondary family members. Also, children are known to be frequent reservoirs of transmission of CRV, especially for other household members. Therefore determining if secondary household contacts, including children, increase the risk of acquiring CRV for the HSCT patient is important in planning their care. 

The purpose of this study was to explore the relationships between the number and age of immediate household contacts in HSCT recipients and acquisition of a CRV infection.

Our study asked two research questions: Is there a relationship between the number of immediate household contacts in HSCT recipients and acquisition of a CRV infection, and is there a relationship between the age of immediate household contacts in HSCT recipients and acquisition of a CRV infection?

After obtaining IRB approval, a descriptive correlational design with a retrospective medical record review was performed. The study sample included outpatients who received an allogeneic (Allo) or autologous (Auto) HSCT at a Comprehensive Cancer Center between July 1, 2006 to July 1, 2008. Data Collection included reviewing patient medical records for 24 months after date of transplant for a positive respiratory viral culture. Age of children less than 18 years and number of members in the HSCT patient household were obtained from the pre-transplant screening assessment.   Exclusion criteria included nosocomial acquisition of CRV and missing medical record data.

The vast majority of CRV infections were experienced by Allo patients (18.1 % compared to 3.8% in the Auto group). Therefore, the regression analysis testing the research questions (hypotheses) focused only on Allo patients. Average time to first CRV infection was 259 days. Having children in the household was a significant predictor of CRV infection but this effect primarily was the result of the 5-12 year age group. This age group was the only predictor of the number of CRV infections (p=0.004) acquired by patients. The number of household members was not a significant predictor. One limitation to the retrospective design of this study is that number and age of household members were obtained prior to HSCT and thus were not assessed at the time CRV was cultured.  Another limitation is that CRV cultures were not available for symptomatic patients that were treated at other healthcare facilities or lost to follow-up.

Conclusion / Why is this study important? The number of children ages 5-12 years significantly increases the risk of an Allo HSCT patient acquiring a CRV infection. While removing children from the household may not be feasible, further studies are needed to address interventions to interrupt household transmission of CRV from children to the vulnerable HSCT patient. These may include:

  • Additional discharge education on infection prevention measures for all household members including children.
  • Re-education of infection prevention measures at periodical intervals throughout the extended post- transplant period.
  • Determining and assessing disinfection practices in the household setting.
  • The effectiveness of Personal Protective Equipment (for patient and/or household members) in the prevention of acquisition of CRV by the HSCT patient.

Furthermore, other vulnerable patient populations that are immunosuppressed, especially for extended periods of time, could potentially benefit from research studies that focus on CRV prevention efforts in the household setting.

 

Contact Information:

Kay Sams, RN, BSN, MPH, CIC

Infection & Prevention Department

Moffitt Cancer Center

12902 Magnolia Dr, Tampa, FL 33612

Kay.sams@moffitt.org

 

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