OBJECTIVES: To provide clinicians with the most reliable, updated evidence to support clinical decision-making and improve outcomes for pa- tients with cancer who are at in- creased risk for infection. DATA SOURCES: Review of two evidence-based sum- maries of prevention of infection interventions published by the On- cology Nursing Society; MEDLINE and guidelines.gov literature re- view. CONCLUSION: Handwashing is the most impor- tant intervention to prevent infec- tion in patients with cancer. Guide- lines-based intravascular catheter care and preventive activities can reduce infection incidence in this vulnerable patient population. Un- derstanding risk factors for aggres- sive pathogens can help identify patients for rapid surveillance and isolation procedures. Additional multi-site research is required in oncology settings to recommend recent interventions for practice. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses should assess their adherence to evidence-based guidelines on infection prevention. Outcomes are optimized when cli- nicians identify high-risk patients and provide scientifically supported interventions. KEYWORDS: Infection, outcomes, cancer, interventions PREVENTION OF INFECTION IN PATIENTS WITH CANCER CHRISTOPHER R. FRIESE I NFECTION refers to the symptoms caused by the multipli- cation of microscopic organisms and subsequent invasion of the body’s natural barriers. 1,2 These organisms may be of bacterial, fungal, viral, or parasitic origin. Patients with cancer, compared with other clinical conditions, are at increased risk for infectious complications. The factors that predispose patients with cancer to infection include decreased supply and/or function of lymphocytes or granulocytes, wounds following invasive surgery, the placement of vascular catheters, nutritional deficiencies, and pre-existing or newly acquired comorbidities. 3 In many cases, patients present with many or all of these factors at once. Preven- tion of infection occurs through activities by patients, nurses, physicians, and public health professionals to reduce the likeli- hood of microbial multiplication and invasion. 1 Despite the recog- nition that patients with cancer are at increased risk for infection, preventive interventions often vary by setting and lack an evi- dence base. The white paper on nursing-sensitive patient outcomes pub- lished by the Oncology Nursing Society (ONS) recognized preven- tion of infection as an important safety outcome that is sensitive to nursing interventions. 4 Four of the 15 outcomes endorsed by the National Quality Forum as nursing-sensitive performance mea- sures are related to infection. 5 Reimbursement strategies for health care services based on quality measures, termed “pay for performance,” are anticipated to increase widely. Moreover, on- cology nurses have an interest in preventing infection in patients with cancer to facilitate timely anti-cancer therapies, promote quality of life, and improve patient satisfaction. It is with these motivations that this article discusses the recent evidence base for interventions to prevent infection. The goal of this review is to provide clinicians with the most reliable, updated evidence to support clinical decision-making and improve outcomes for pa- tients with cancer who are at increased risk for infection. Christopher R. Friese, RN, PhD, AOCN®: Center for Outcomes & Policy Research, Dana-Farber Cancer Institute; Cancer Pre- vention Fellow, Harvard School of Public Health, Boston, MA. Address correspondence to Christopher R. Friese, RN, PhD, AOCN ® , Harvard School of Public Health, 44 Binney St. SM 271, Boston, MA 02115. Fax: (617) 344-0427. © 2007 Elsevier Inc. All rights reserved. 0749-2081/07/2303-$30.00/0 doi:10.1016/j.soncn.2007.05.002 174 Seminars in Oncology Nursing, Vol 23, No 3 (August), 2007: pp 174 –183