The importance of education of infection control practices to acute lymphoblastic leukemia patient families for 2019-nCoV prevention
Authors: Xie Lichun , Ye Hui-ying , Long Qing-ling , Liu Si-xi , Wen Feiqiu 
Published: October 2020

Abstract
Background: With the outbreak of coronavirus disease 2019 (2019-nCoV, also named COVID-19) and growing knowledge of its epidemiological characteristics, it has been clear that children with acute lymphoblastic leukemia (ALL) are also susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: In the past four months, we educated the guardians of children with leukemia with a series of preventative measures, including ⑴ Hand Hygiene and Hand Care; ⑵ the use of masks; ⑶ separation and sterilization of patient items; ⑷ avoiding public transportation; ⑸ Staying at home unless medically necessary; ⑹ Telemedicine; ⑺ Allowing only one caretaker during hospital admission ⑻ minimizing patients and their families visiting or travelling. We conducted a retrospective review to study the relationship between compliance with personal preventive measures and exposure to 2019-nCoV among children will ALL and their caretakers before and during the outbreak of 2019-nCoV in China between Jan 21-May 23 of 2020. Results: Prior to the outbreak of coronavirus 2019-nCoV in Jan 2020, 88.9% of patients washed their hands before meals and 55.6% after they ate. All of the patients who are >3 years old and 91% of the patients <3 years olds wore face masks regularly as a strategy for protection in the outdoors. When in the hospital, 95.5% of the patients who are >3 years old and 78% of the patients <3 years olds wore face masks regularly as a strategy for protection. Since the outbreak of coronavirus 2019-nCoV in China in Jan, 2020, the percentage of compliance to hand-washing before and after meals rose to 100% for all patients, as well as the compliance of regular mask use was 100%. Similar trend is also seen in the caretakers, prior to the outbreak 75% of whom washed their hands before and 66.7% after they ate or handed food. ALL of them wore masks regularly in the hospital or outdoors. Since the outbreak, 100% of caretakers wore masks during outside and in the wards. Regardless of the children with ALL are immunocompromised patients, key message of infection prevention provided to the families were using alcohol to disinfect surfaces, avoid going to public transport and without visitor or travelling. Prior to the outbreak, internet consults consisted of 20% out of all patient consults. As of date, which is 160 days since the outbreak, 80% of patient consults are done via internet. ALL of patients are voiding public transportation. Private cars and taxi are their choices. ALL of them comply with the policy of just one companion and stayed at home unless have to get IV chemo or got likely infection. In April 2019, 21.38% of the ALL patients in inpatient department suffered febrile neutropenia. Otherwise, in April 2020, only 5.18% suffered febrile neutropenia.Conclusion: From Jan 22 of 2020 to the authorship of this report, within the 200 number of ALL patients whom we have provided care for in Shenzhen Children’s hospital, none of the patients as well as their families were infected with 2019-nCoV, and all of them received chemotherapy as planned. The infection rate of ALL patients suffered febrile neutropenia decreased by seventy-five percent. These outcomes demonstrated that our response to the public health emergency was on-time and appropriate. The operational result shows that the control measures taken are effective. Our experience suggest that offering prompt and appropriate instructions in addition to provision of regular education and preventative practices to patients and their families may be considered to other pediatric oncology centers around the world.