Neutropenic Precautions are Infection Control Nursing Procedures that are applied when patient has a high risk of bacterial infections due to low Neutrophil count (Neutropenia).
Since the Neutrophil fights infections and defends the body against pyogenic bacteria (Bacteria that doesn’t cause Pus), the body or the immune system may not be able to fight the invading microorganisms if the Neutrophil produced or circulating in the blood is insufficient. Possible exposure to bacteria and infections would be very risky in such a case.
The Neutropenic Precautions are followed to guard patients with a low white blood cell count or a depressed immune system from the possibility of exposure to or contact with the infecting microorganisms. The precautions are an alternative method if increasing the white blood cells count is not possible or undesirable at the precautions are applied.
In other words, Neutropenic Precautions are procedures to follow when a low White Blood Cells count (WBC Count) is desired, or when increasing the WBC Count is not the option to defend the body from the invading microorganisms. For example, the treatment of Systemic Lupus Erythematosus (SLE) requires the count of white blood cells that are attacking the non-harmful body tissues to be reduced and Neutropenic Precautions would be necessary in such a case to avoid infections.
Neutropenic Precautions are usually required in the following cases:
- Neutropenia or Agranulocytosis. Agranulocytosis is the decrease to normal white blood cell count of Granulocytes (Neutrophil, Eosinophil, and Basophil) that causes a differential count increase to the Agranulocytes (Monocytes and Lymphocytes).
- Immunosuppressive Therapy where the decreasing the production and count of White Blood Cells is required.
- Severe or Extensive non-infected Burns where a great possibility of infection is expected if bacteria comes in contact with the skin. When the skin surface heals enough that surrounding environment wouldn’t be risky, the procedure can stops.
- Acquired Immunodeficiency Syndrome (AIDS) until the WBC Count increases into non-risky levels.
- Blood cancers such like Hodkin’s Lymphoma and Acute Leukemia .
- Skin diseases such like Dermatitis and Bullous.
The Neutropenic Precautions are not standardized and each health care institution has its own infection control policy in this regard. The precautions level and period of time also varies from one patient to another depending on the degree and causes of the patient’s immunosuppression.
The following Neutropenic Precautions may or may not be applied on the patient depending on the facility Infection Control policy and the patient’s condition:
- The patient should be placed in a single room.
- The patient room must be cleaned and equipped with new or scrupulously equipment.
- The patient room can be equipped with positive air pressure (air pressure higher than the surrounding rooms) to assure that the air flows from inside the room to surrounding environment and prevent the air to travel in the opposite direction. The air pressure will also work on pushing the suspended particles to low levels in the air and push them out of the room.
- The room cannot have any plants or flowers.
- The staff members that work with the patient must be illness and infection free. They have to wear gloves and gown. In severe patient conditions, sterile gown, gloves, and mask may be required.
- Hands must be washed before putting on the gloves and after taking them off.
- Neutropenic Precautions need to be explained to the patient, family members, and visitors to ease anxiety and promote their cooperation.
- Traffic to the room should be limited to only the health care professionals who are working the patient.
- Neutropenic Precautions card can be placed on the room door to bring the staff member attention into the situation as well instructing family members and visitors to consult the staff members before entering the room.
- Family members and visitors may be required to wash their hands, put gown on, and wear mask if the patient condition requires that.
- House Keeping need to be instructed to wear gloves, gown and mask before entering the room and to keep any unnecessary cleaning equipment outside the room.
- The patient diet must contain only cooked food and only sterile beverage. Raw and partially cooked meat, vegetables, and fruit are prohibited.
- Supplies must be kept in a clean enclosed cart or outside the room.
- The patient shouldn’t be transported to another department, unless for a necessity. If the patient is being moved, they are required to wear a gown and a mask, the receiving the need to be alerted to take the Neutropentic Precautions in their consideration before receiving the patient.