Vitamin D has also generated interest as a potential anti-cancer agent. Sources of vitamin D include cutaneous synthesis upon exposure to sunlight, dietary intake, and supplements.
A Patient’s Story
Evidence for the efficacy of vitamin D supplements with or without calcium in preventing cancer incidence is available as a secondary endpoint from randomized controlled trials, with a summary of the results from three trials providing evidence of lack of efficacy. None of the randomized controlled trials mentioned above studied multivitamin supplements as commonly taken by the general U. In the PHS II, 14, male physicians were randomly assigned to receive either a daily multivitamin supplement or a placebo for a median of 11 years.
The overall reduction in cancer risk was more pronounced in men who had been diagnosed with cancer before the study began HR, 0. This puzzling result, along with the weak association and multiple statistical comparisons made for many different trial endpoints, diminishes the strength of evidence provided by the PHS II trial. The relationship between environmental pollutants and cancer risk has been of long-standing interest to researchers and the public. When estimates of the potential burden of cancer have been calculated for different classes of exposure, the factors described earlier, such as cigarette smoking and infections, have represented much greater proportions of the cancer burden than have environmental pollutants.
Nevertheless, some associations between environmental pollutants and cancer have been clearly established. Perhaps because the lung is most heavily exposed to air pollutants, many of the most firmly established examples of pollutants and cancer relate specifically to lung cancer, including secondhand tobacco smoke, indoor radon, outdoor air pollution, and asbestos for mesothelioma.
Another environmental pollutant linked with cancer is highly concentrated inorganic arsenic in drinking water, which is causally associated with cancers of the skin, bladder, and lung. Many other environmental pollutants, such as pesticides, have been assessed for risk with human cancer, but with indeterminate results. There are challenging methodological issues to address in these studies, such as accurately measuring exposures for long periods, which often make it difficult to clearly establish an association between an environmental pollutant and cancer.
The list of topics considered above is not exhaustive. Other lifestyle and environmental factors known to affect cancer risk either beneficially or detrimentally include certain sexual and reproductive practices, the use of exogenous estrogens, and certain occupational and chemical exposures. In this summary, factors were selected that appear to impact the risk of several types of cancer and that have been identified as being potentially modifiable.
These include cigarette smoking, which has been conclusively linked with a wide range of malignancies; avoidance of cigarette smoking has been shown to reduce cancer incidence. Other potential modifiable cancer risk factors include alcohol consumption and obesity; physical activity is inversely associated with the risk of certain cancers. More research is needed to determine whether these associations are causal and whether avoiding risk behaviors or increasing protective behaviors would actually reduce cancer incidence.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above. Description of the Evidence. Added text to state that the expectation is that, if a risk factor truly causes cancer, it would also be the case that a lifestyle modification i. Because observational studies rarely provide conclusive evidence of such relationships, additional evidence is required cited Song et al.
Added text to state that the risk of cancer-specific death after a solid organ transplant is higher during the first 6 months posttransplant but persists for many years; it is especially high for cancers linked to viral infections. Added text to state that a recent analysis of the long-running Nurses' Health Study and Health Professionals Follow-up Study estimated the proportions of cancer cases and deaths in the U.
Also added text to state that one major weakness of the study was that its premise assumed the causality of the nonsmoking risk factors; the analysis was further weakened by using self-reported measures of diet and alcohol use, and by measuring only leisure-time physical activity. Also, the authors did not present the effects of the nonsmoking risk factors after accounting for smoking; this analysis and others with similar weaknesses should therefore be interpreted cautiously cited Song et al. This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about cancer prevention.
It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions. Board members review recently published articles each month to determine whether an article should:. Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
Any comments or questions about the summary content should be submitted to Cancer. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries. Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches.
The PDQ Screening and Prevention Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations. PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. Permission to use images outside the context of PDQ information must be obtained from the owner s and cannot be granted by the National Cancer Institute.billingsapp.com/kinder-unter-dem-einfluss-des.php
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Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online , a collection of over 2, scientific images. The information in these summaries should not be used as a basis for insurance reimbursement determinations.
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Research Tools, Specimens, and Data. Statistical Tools and Data. Grants Policies and Process. Introduction to Grants Process. Peer Review and Funding Outcomes. Annual Reporting and Auditing. Transfer of a Grant. Cancer Training at NCI. Funding for Cancer Training. Building a Diverse Workforce. The live-attenuated influenza vaccine LAIV may shed vaccine virus at very low levels for some time after administration, and person-to-person transmission of the vaccine strain virus is theoretically possible [ 45 , 46 ].
Transmissibility of vaccine virus is rare [ 47 ], and no cases of person-to-person transmission of LAIV have been documented in the healthcare setting.
Infection Prevention in the Cancer Center
At this time, no recommendations exist to exclude LAIV in populations other than those described above. Transmission of varicella vaccine virus from the varicella vaccine, but not the zoster vaccine, has been documented, although transmission is uncommon [ 48 ]. Recommendations state that personnel who, within the first 42 days of receiving the varicella vaccine, develop a rash that cannot be covered should avoid any contact with immunosuppressed patients until the rash is crusted [ 26 ].
We believe a similar policy should be followed for zoster vaccine. Leukemia patients and HSCT recipients often have prolonged hospitalizations. They may have a large number of visitors both in the hospital and at home while still profoundly immunosuppressed. All visitors should be instructed on basic infection prevention including hand hygiene techniques and isolation procedures. In the hospital, a system should be established whereby all visitors can be screened for potential transmissible diseases [ 1 ].
The CDC recommends that any visitor with an upper respiratory tract infection, a flu-like illness, a herpes zoster rash whether covered or not , or recent known exposure to any transmittable disease should not be allowed access to the unit or should at least be restricted from visiting severely immunosuppressed patients [ 1 ].
Likewise, visitors should be asked about recent vaccinations, and any with a recent history of oral polio vaccination or those who develop a rash within 6 weeks of live-attenuated varicella-zoster virus vaccination should also be restricted [ 43 , 48 ]. Healthcare personnel with a disease transmitted by air, droplet, or direct contact should be restricted from direct patient contact [ 1 ]. At times, the cancer center patient, even those with severely depressed immune systems, may be cared for in healthcare settings outside the cancer center.
Whenever possible, these patients should be cared for in single-patient rooms and the infection prevention measures outlined above should be followed. Although there are no specific neutropenic precautions per se, many hospitals create their own isolation category to educate noncancer center staff on the prevention of infection in profoundly neutropenic patients, addressing a variety of issues, such as specialized diets and viral respiratory precautions. A majority of cancer treatment is delivered in the outpatient setting [ 49 ]. Many patients receive all of their treatment in the outpatient setting whereas others, particularly HSCT recipients, remain immunosuppressed and at risk for developing infections after discharge from the inpatient cancer center.
The CDC recommends that all outpatient oncology centers have a formal infection prevention program; detailed guidelines for infection control after hospital discharge are available from the CDC [ 1 , 50 ].
Description of the Evidence
Special care should be given to educate patients and healthcare workers regarding measures to reduce risk of exposure to infectious pathogens, such as common bacteria, community respiratory viruses, and fungi. In addition, clinicians and infection prevention experts should be aware of the local epidemiology and important antibiotic-resistant pathogens prevalent in the cancer center population as well as potential strategies to reduce exposure to and infection by these organisms.
Finally, infection prevention experts should be aware of unique issues regarding HAI prevention in the cancer center. Potential conflicts of interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. National Center for Biotechnology Information , U.
Published online May 7. Received Jan 11; Accepted Apr For Permissions, please e-mail: This article has been cited by other articles in PMC. Abstract Cancer patients are frequently immunosuppressed and at risk for a wide range of opportunistic and healthcare-associated infections. Antibiotic Prophylaxis to Prevent Infection Prophylactic antibiotics, most commonly fluoroquinolones, are often given to patients considered at high risk for serious infection. Device-Associated Infections Because of the unique needs of cancer patients, intravascular catheters, particularly tunneled or implantable catheters, are used more often and for longer durations in these compared to other hospitalized patients as catheters provide long-term access for frequent blood draws and infusion of chemotherapy and blood products.
Community Respiratory Viruses Infection with common community respiratory viruses can lead to serious disease and significant morbidity and mortality among patients with cancer, especially HSCT recipients. Modes of Transmission and Isolation Requirements. Open in a separate window. Fungal Pneumonia Invasive pulmonary aspergillosis and other fungal pneumonias are a serious concern, particularly in patients with prolonged neutropenia or HSCT recipients [ 28 , 29 ].
The health professional's role in preventing nosocomial infections | Postgraduate Medical Journal
Multidrug-Resistant Organisms Historically, cancer centers used surveillance cultures of the skin or perirectal areas to guide empiric antibiotic therapy for patients with neutropenic fevers. Key components of an infection prevention program in the cancer center. Note Potential conflicts of interest.
Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: Biol Blood Marrow Transplant.
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The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus , vancomycin-resistant enterococcus , and healthcare-associated bloodstream infections: Effect of daily chlorhexidine bathing on hospital-acquired infection.
N Engl J Med. Periodontal disease and periodontal management in patients with cancer. International Bottled Water Association. Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. Prophylaxis with fluoroquinolones for bacterial infections in neutropenic patients: Efficacy of quinolone prophylaxis in neutropenic cancer patients: Antibiotic prophylaxis reduces mortality in neutropenic patients.
Efficacy of oral prophylactic antibiotics in neutropenic afebrile oncology patients: A systematic review of randomised controlled trials. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: Fluoroquinolone resistance of Escherichia coli at a cancer center: Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile -associated diarrhea: Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: A prospective cohort study.
Guideline for prevention of catheter-associated urinary tract infections Infect Control Hosp Epidemiol. Management of respiratory viral infections in hematopoietic cell transplant recipients.
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Am J Blood Res. It has never been shown that wearing surgical facemasks decreases postoperative wound infections. When originally introduced, the primary function of the surgical mask was to prevent the migration of microorganisms residing in the nose and mouth of members of the operating team to the open wound of the patient. However, it is now recognised that most bacteria dispersed by talking and sneezing are harmless to wounds.
The difference was not significant. Thus while masks may be used to protect the operating team from drops of infected blood and from airborne infections, they have not been proven to protect the patient. Some health personnel have difficulty in accepting that the stethoscope, the symbol of their professional status, may actually be a vector of disease.
There are no studies on the beneficial effect of regularly cleaning stethoscopes on nosocomial infection rates. Like the stethoscope, the white coat has long been a symbol of the medical professional. Many institutions insist that junior doctors, in particular, wear a white coat as part of a mandatory dress code. About half of all patients still prefer their doctor to wear one. The recommendation that the coat is removed and a plastic apron is donned before wound examination is rarely followed in practice.
While few would challenge the sartorial elegance of the white coat, clearly its value needs to be critically assessed. There is little microbiological evidence for recommending changing white coats more often than once a week, or for excluding the wearing of white coats in non-clinical areas. The insertion of an intravenous needle or cannula results in a break in the body's natural defences.
Organisms can enter the circulation from contaminated fluid or a giving set, or can grow along the outer surface of the cannula. Prevention of complications requires careful insertion practice and optimal catheter care. Inserting a peripheral catheter demands the same precautions as for any surgical procedure. The hands should be disinfected with alcohol and gloves should be worn. The insertion site should not be touched after disinfection. The use of a clear, adhesive, bacteria impermeable dressing to secure the cannula has become popular.
These dressings may be contraindicated as they allow accumulation of blood, sweat, and exudate, which may promote growth on and in the underlying skin. Indeed, a meta-analysis showed a significantly increased risk of catheter tip infection when transparent rather than gauze dressings were used with either central or peripheral catheters. Routine replacement of the intravenous line every three to five days is common practice in the USA but not in Europe.
Guidelines developed by the Centers for Disease Control and Prevention recommend that peripheral intravenous catheters be changed every three days. However, routine replacement of central venous catheters was no longer supported in their latest update. Containers of intravenous fluids are usually changed before significant growth occurs, but the giving set does not need to be replaced more often than every 72 hours.
Practical methods for preventing nosocomial infection What's in. Methods for preventing nosocomial infections are summarised in box 2. Nosocomial infections are worth preventing in terms of benefits in morbidity, mortality, duration of hospital stay, and cost. Educational interventions promoting good hygiene and aseptic techniques have generally proved to be successful, but these practices are often not sustainable. Greater efforts are being made in some countries to ensure the application of the infection control evidence base into practice. You will be able to get a quick price and instant permission to reuse the content in many different ways.
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