# A 12-year-old child with Hodgkin's disease is receiving chemotherapy. Which nursing intervention is most important to prevent infection during treatment?

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## 문제

A 12-year-old child with Hodgkin's disease is receiving chemotherapy. Which nursing intervention is most important to prevent infection during treatment?

What is the priority nursing intervention to prevent infection in a pediatric patient with Hodgkin's disease receiving chemotherapy?

## 보기

1. Encourage the child to participate in group activities with other hospitalized children
2. Implement strict hand hygiene and limit visitors with signs of illness **✔ 정답**
3. Provide a high-protein diet with fresh fruits and vegetables
4. Administer prophylactic antibiotics as ordered by the physician

**정답: 2**

## 해설

Strict hand hygiene and limiting visitors with signs of illness are the most fundamental and effective measures to prevent infection in immunocompromised patients receiving chemotherapy.

For a pediatric patient with Hodgkin's disease undergoing chemotherapy, infection prevention is the most important nursing intervention. Chemotherapy drugs target rapidly dividing cells, which includes not only cancer cells but also normal immune cells, especially white blood cells (neutrophils, lymphocytes). This leads to neutropenia and impaired immune function, making the child extremely vulnerable to opportunistic infections.

The most important nursing interventions are implementing strict hand hygiene protocols and limiting exposure to sources of infection. Hand hygiene is the single most effective method to prevent healthcare-associated infections and stop pathogen transmission. All healthcare staff, family members, and visitors must perform proper hand hygiene before and after contact with the patient. Additionally, restricting visitors who show signs of illness (fever, cough, runny nose, or other infection symptoms) is essential to minimize pathogen exposure.

During chemotherapy treatment, the child's absolute neutrophil count (ANC) may drop to dangerously low levels (neutropenia), typically occurring 7–14 days after chemotherapy administration. This period is when the risk of serious infection is highest. The nursing team must monitor for signs of infection, including fever (often the only early sign), changes in vital signs, altered mental status, or other abnormal symptoms.

Environmental modifications are also important, including keeping the patient's room clean, using appropriate isolation precautions when necessary, and ensuring proper food safety measures. When possible, the child should be placed in a private room, and all equipment must be properly disinfected between uses.

## 심화 해설

Understanding the Priority: Infection Prevention in Chemotherapy-Induced Neutropenia

For a 12-year-old child with Hodgkin's disease undergoing chemotherapy, the most critical nursing intervention to prevent infection is implementing strict hand hygiene and limiting visitors with signs of illness. This is the priority because chemotherapy agents target rapidly dividing cells, which includes not only the malignant lymphoma cells but also the healthy hematopoietic stem cells in the bone marrow. The resulting myelosuppression leads to a significant drop in absolute neutrophil count (ANC), a condition known as neutropenia. According to the evidence, neutropenia is clinically defined by a neutrophil count falling below 1,500 cells/μL, which directly and severely increases the patient's susceptibility to life-threatening infections [1].

Why the Other Options Are Not the Priority

While the other options contain elements of care, they fail to address the most immediate and evidence-based source of infection risk or are contraindicated in the neutropenic patient.

- Option 1: Encourage the child to participate in group activities with other hospitalized children. This intervention is contraindicated during the nadir period (the point of lowest blood cell counts after chemotherapy). Group settings exponentially increase the child's exposure to potential pathogens from other individuals, making this a high-risk activity that directly contradicts strict infection control principles [1].

- Option 3: Provide a high-protein diet with fresh fruits and vegetables. Although nutritional support is vital for recovery, fresh fruits and vegetables harbor bacteria and fungi that a neutropenic gut cannot defend against. The standard of care for a profoundly neutropenic patient is a low-microbial or "cooked" diet to minimize the introduction of pathogens through the gastrointestinal tract. This option introduces a significant source of infection.

- Option 4: Administer prophylactic antibiotics as ordered by the physician. Administering prophylactic antibiotics is a valid medical intervention in certain high-risk protocols, but it is a dependent nursing action that requires a physician's order. More importantly, it is not the first line of defense or the most impactful independent nursing intervention. The primary strategy for infection prevention, as highlighted in evidence-based clinical management, begins with strict infection control practices, which are the nurse's direct responsibility [1].

The Evidence-Based Rationale for Strict Hand Hygiene and Visitor Limitation

The foundational approach to protecting a neutropenic patient is minimizing the entry of pathogens into their environment and breaking the chain of infection. The evidence-based nursing strategies for neutropenic patients explicitly prioritize strict infection control as the first domain of clinical management [1]. This encompasses meticulous hand hygiene for all individuals—staff, patient, and visitors—as the single most effective method to prevent the transmission of infectious agents. Limiting visitors who exhibit any signs of illness is a direct application of this principle, creating a protective barrier around the child whose immune system is profoundly compromised. This intervention is an independent nursing action that can be implemented immediately and continuously, forming the cornerstone of safe care during the vulnerable period of chemotherapy-induced myelosuppression [1].References (research sources)

- [1]Optimizing nursing care for neutropenic patients: a holistic perspective on education, support, and clinical management.Research articleXu ZN, Gao LP, Wang XK, Yu XL, Cong Y, Wang PJ. (2025) · DOI: 10.3389/fmed.2025.1633708

## 임상 시나리오

Infection Prevention for Chemotherapy-Induced NeutropeniaProtecting the Pediatric Patient During the Nadir
The highest priority is strict hand hygiene for all staff, visitors, and the patient. This is the single most effective method to prevent pathogen transmission.

Actively screen and restrict visitors who show any signs of illness, such as cough, fever, or rhinorrhea. Limit the total number of visitors to reduce exposure risk.

Place the patient in a private room with protective precautions. Avoid invasive procedures like rectal temperatures or suppositories that can breach the mucosal barrier and introduce bacteria.

CautionAn ANC below 500 cells/μL indicates severe neutropenia and extreme infection risk. A low-microbial diet (no fresh fruits/vegetables) is required, and live plants or flowers are prohibited in the room.

## 핵심 개념

- **Neutropenia** — An abnormally low absolute neutrophil count (ANC), typically below 1,500 cells/μL, severely increasing susceptibility to infection.
- **Myelosuppression** — A decrease in bone marrow activity resulting in reduced production of blood cells, a common side effect of chemotherapy.
- **Nadir** — The point in time after chemotherapy when blood cell counts are at their lowest, representing the period of highest infection risk.
- **Absolute Neutrophil Count (ANC)** — A measure of the number of neutrophil granulocytes in the blood, used to assess a patient's risk for infection.
- **Low-microbial diet** — A diet designed to minimize the intake of bacteria and fungi, typically excluding fresh fruits and vegetables for neutropenic patients.

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