Nurses in Oncology on Vaccination, AMR and Infection Controle

“Why nurses are paramount in the context of antimicrobial resistance (AMR) and vaccination for cancer patients”

Patrick Crombez, Vice President

Antimicrobial resistance will soon threaten the routine treatment of common infections across the world and have an ever-greater impact on morbidity and mortality in vulnerable patients like cancer patients. These patients often are neutropenic and immunocompromising effects of the underlying disease as well as of antineoplastic therapies, especially with the emerging new treatment options as immunotherapy, must be considered by cancer nurses as high risk factors for developing resistant infectious complications. 

Vaccination is one of the strategies needed to counter this threat and can be an effective preventive strategy against many infections, but type and timing of vaccinations must be carefully chosen to allow for optimal immunization in immunocompromised patients. Certain therapeutic interventions result in profound immunologic challenges and requiring specific vaccination strategies (Rieger et al. 2018). 

Vaccines prompt the human body to issue an immune response to an invading organism, preventing infection from occurring in the first place, thereby reducing the need to use antimicrobials.  The second mechanism by which viral vaccines can reduce AMR is by prevention of inappropriate antibiotic prescriptions for secondary bacterial infections caused by viral pathogens. Cancer patients are almost 50 times more likely to die from for example flu-related complications, yet the vaccination uptake in this group is just over 50% (Public Health England 2018a). As in some European countries specialized (cancer) nurses may prescribe medication, and so also antibiotics, they have a responsibility to take up and are in a strong leadership position to promote appropriate use of antibiotics in everyday practice.

As there is a proven direct correlation between antibiotic use and the emergence of resistance, reducing the number of antimicrobial drugs used, will have an impact on AMR and justifies why nurses have to take the leadership in programs as Antimicrobial Stewardship (AS) in order to advocate for optimal use of antimicrobials. Another key intervention is Infection Prevention and Control (IPC) measures which together with AS form a package of interventions that nurses deliver in their everyday roles. 

Nurses’ knowledge about infectious epidemiology in their hospital is paramount to participate in IPC programs.   Leadership role of nurses to support the multidisciplinary team to apply IPC principles and best practices is essential. The critical partnership of infection prevention, for healthcare associated infections, and antimicrobial stewardship is not fully acknowledged, and the role nurses undertake daily in preventing infections must be recognized and cannot be overemphasized. 

To optimize the full integration of cancer nurses in these activities, they need to acquire knowledge based on research evidence about AMR and vaccination to avoid misconceptions as it is often present in the general population. It is obvious that nurses must be aware of the changing nature of challenges to educate their patients and their families to counter misinformation they’ve read online. The knowledge and skills of nurses and other health professionals must be harnessed to provide education to patients, other healthcare providers and to the public about the benefits of vaccination and immunization and the risks of inappropriate use of antibiotics.

In conclusion
Nurses, as the largest health workforce, and nursing organizations are part of the development of robust governance on infection prevention, an increasingly complex and constantly changing field. Cancer nurses have a real opportunity to take up leadership and to make a difference in the prevention of the global threat of AMR by promoting and educating about justified use of antimicrobials and vaccination. The first step, as healthcare provider, is that nurses themselves are correctly vaccinated.

The Nurses Guide on Vacciantion, AMR and Infection-Controle will contribute significantly to the outcome on nurses engagement, participation and responsibility.

September 10^th 2019
#VaccinationSummit19

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References

Public Health England (2018a) Seasonal Influenza Vaccine Uptake in GP Patients: Winter Season 2017-2018.

Rieger CT, Liss B, et al. Anti-infective vaccination strategies in patients with hematologic malignancies or solid tumors-Guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Oncol. 2018;29(6):1354–1365. doi:10.1093/annonc/mdy117

A Elkrief, L Derosa, G Kroemer, L Zitvogel, B Routy, The negative impact of antibiotics on outcomes in cancer patients treated with immunotherapy: a new independent prognostic factor? Annals of Oncology, 2019;mdz206, https://doi.org/10.1093/annonc/mdz206 

ICN survey 'The Role of Nurses in Immunisation" 2018 https://www.icn.ch/sites/default/files/inline-files/IMMUNISATION_Report%20%28002%29.pdf 

ESNO nurses Guide in process on Vaccination, AMR and Infection control 2019 - 2020 https://www.esno.org/microbial-issues.html