By Steve Blanchard - February 16, 2023
Some of the most at-risk patients for infection are those who have had blood or marrow transplants or cellular immunotherapy. That’s why the nursing staff at Moffitt Cancer Center has taken preliminary steps to help reduce infection with proper oral care.
According to Melanie Fyfe, a nurse in Moffitt’s Blood and Marrow Transplant and Cellular Immunotherapy Department, proper and elevated oral care for this patient population is an important way to help decrease risk of infections such as pneumonia and blood stream infections. She presented research on these findings Feb. 17 at the 2023 Tandem Meetings, the combined annual meetings of the American Society for Transplantation and Cellular Therapy and Center for International Blood and Marrow Transplant Research.
According to Fyfe, blood and marrow transplant and cellular immunotherapy patients receive high doses of chemotherapy that cause a decrease in blood counts, placing them at a high risk for infection. Mucositis, an inflammation of the gastrointestinal tract that begins orally with sores or irritations on the mouth or inside of the mouth or throat, is a common side effect of treatment.
“It can be very painful,” Fyfe said. “Some patients who have experienced it say it feels like they are swallowing glass. Patients are given medications to help with pain so that they can swallow because hydration and nutrition are important, but ulcerations need to remain clean to minimize infection risk and reduce pain.”
Fyfe explained that when a patient is first consulted for a blood and marrow transplant or cellular immunotherapy procedure, they are presented with information about how to best care for themselves and how to prevent infection. Included in that information is how to perform oral care and an approved list of oral hygiene products that are American Dental Association recommended and nonalcoholic.
Moffitt updated its oral care protocol for all patients in the summer of 2020 to meet ADA standards for acute care patients, but it is different than what you would do at home. Nurses are regularly reminding patients of how to properly care for their oral hygiene, whether they are inpatient or outpatient.
"We discourage flossing because our patients have a high risk of bleeding."- Melanie Fyfe, BMT-CI nurse
“Some of our protocol is what you expect, brush in the morning, after meals and before you go to bed,” Fyfe said. “We discourage flossing because our patients have a high risk of bleeding.”
Using mouth rinses and mouth/lip moisturizers are also part of the protocol and can greatly improve patient comfort.
Patients are encouraged to brush and rinse their mouth at least four times a day and even more often if they are vomiting or have mucositis. Patient education handouts, ADA approved product handouts and mirror oral care reminder checklists are just some of the interventions used to increase oral care.
Fyfe said the new protocols on oral hygiene have decreased infections in patients. It’s her hope that the practice will be implemented across all health care facilities to help all patient populations, not just those in blood and marrow transplant and cellular immunotherapy.
“Our goal is to show how this evidence-based practice decreases infections and share the knowledge we’ve gained,” Fyfe said.