What guidelines should hospitals follow to prevent infections in hospitalized patients who are immunocompromised (having a weakened immune system)?

From the Guidelines

Hospitals should prioritize hand hygiene as the most effective means of preventing transmission of infection in immunocompromised patients, as recommended by the Infectious Diseases Society of America 1. To prevent infections in hospitalized immunocompromised patients, hospitals should implement comprehensive infection prevention protocols.

Key Recommendations

• Hand hygiene with alcohol-based sanitizers or soap and water before and after patient contact is crucial 1.
• Standard barrier precautions should be followed for all patients, and infection-specific isolation should be used for patients with certain signs or symptoms 1.
• High-risk patients, such as HSCT recipients, should be placed in private rooms with HEPA filtration 1.
• Environmental surfaces should be disinfected regularly with hospital-grade disinfectants.
• Antimicrobial prophylaxis may be indicated for specific patients, such as trimethoprim-sulfamethoxazole for Pneumocystis pneumonia prevention or fluconazole for candidiasis prevention.
• Hospitals should also implement central line care bundles, including chlorhexidine skin preparation, maximal barrier precautions during insertion, and daily assessment of line necessity.
• Visitor restrictions, HEPA filtration in high-risk areas, and regular microbiological surveillance are essential components of infection prevention.

Additional Considerations

• Avoid using carpeting, upholstered furniture, or furnishings in rooms occupied by severely immunocompromised patients 1.
• Plants and dried or fresh flowers should not be allowed in the rooms of hospitalized neutropenic patients 1.
• Hospital work exclusion policies should be designed to encourage healthcare workers to report their illnesses or exposures 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE

1. 2 Prophylaxis of Invasive Aspergillusand CandidaInfections Posaconazole delayed-release tablets are indicated for the prophylaxis of invasive Aspergillusand Candidainfections in patients who are at high risk of developing these infections due to being severely immunocompromised, such as hematopoietic stem cell transplant (HSCT) recipients with graft-versus-host disease (GVHD) or those with hematologic malignancies with prolonged neutropenia from chemotherapy [see Clinical Studies (14.2)]as follows: • Posaconazole delayed-release tablets:adults and pediatric patients 13 years of age and older.

The guidelines for hospitals to prevent infections in hospitalized patients who are immunocompromised include:

• Prophylaxis of invasive fungal infections: Posaconazole delayed-release tablets are indicated for the prophylaxis of invasive Aspergillus and Candida infections in patients who are at high risk of developing these infections due to being severely immunocompromised.
• Patient population: Hematopoietic stem cell transplant (HSCT) recipients with graft-versus-host disease (GVHD) or those with hematologic malignancies with prolonged neutropenia from chemotherapy.
• Age range: Adults and pediatric patients 13 years of age and older. 2

From the Research

Guidelines for Preventing Infections in Immunocompromised Patients

• Hospitals should follow strict infection control protocols to prevent the spread of infections in immunocompromised patients, as they are at a higher risk of developing infections due to their compromised immune system 3, 4.
• The use of antimicrobial prophylaxis, such as Trimethoprim-Sulfamethoxazole (TMP-SMX), can be effective in preventing infections like Pneumocystis jirovecii pneumonia (PCP) in immunocompromised patients 5, 6.
• Low-dose TMP-SMX therapy may be a suitable alternative to conventional-dose therapy, as it has been shown to reduce adverse events while maintaining efficacy in treating PCP 5, 6.

Surgical Site Infection Prevention

• Immunocompromised patients are at a higher risk of surgical site infections (SSIs) and wound complications, and therefore, require special consideration in the perioperative period 7.
• Partial skin closure has been shown to be effective in reducing SSIs in immunocompromised patients 7.
• The use of prophylactic negative pressure wound therapy is not supported by sufficient evidence, and its use should be carefully evaluated on a case-by-case basis 7.

Infection Management

• Infection management in immunocompromised patients requires a multidisciplinary approach, taking into account the patient's underlying condition, the type of infection, and the potential interactions between antimicrobial agents and other medications 4.
• The reasonable use of anti-infectives in prophylaxis and therapy is crucial to prevent the development of antibiotic-resistant pathogens and to minimize the disruption of the microbiome 4.