The research, published in BMC Nursing, was conducted at the Children’s Cancer Hospital Egypt (CCHE) 57357, one of the largest pediatric oncology centers in the Middle East. A team of nursing researchers led by Amira El-Sayed of October 6 University in Giza set out to answer a deceptively simple question: if you teach pediatric oncology nurses about mucormycosis in a systematic way, do their knowledge and their actual bedside practices improve? The answer, measured with rigorous before-and-after assessments, was a resounding yes, at least in the short term. The findings arrive at a moment when clinicians worldwide are paying renewed attention to fungal infections, which are increasingly recognized as a growing danger for patients whose immunity has been compromised by cancer therapy, transplantation, or other modern medical interventions.

Mucormycosis is caused by fungi in the order Mucorales, ubiquitous organisms that most healthy people encounter daily without consequence. In an immunocompromised host, however, these molds can germinate and invade blood vessels, causing tissue death, a process known as angioinvasion. The disease can manifest in the rhinocerebral form, attacking the sinuses and brain; the pulmonary form, destroying lung tissue; or the gastrointestinal and cutaneous forms, each carrying substantial mortality. Children with hematologic malignancies such as leukemia, and those undergoing hematopoietic stem cell transplantation, sit squarely in the highest-risk category. Neutropenia, the depletion of infection-fighting white blood cells induced by chemotherapy, removes the body’s primary cellular defense against these fungi. Because early diagnosis is difficult and treatment options are limited, prevention becomes paramount, and prevention in a hospital setting depends heavily on the vigilance of nursing staff.

Nurses occupy a uniquely influential position in infection prevention. They control the environment around the patient, from the cleanliness of surfaces and equipment to the handling of food, the management of personal protective equipment, and the early recognition of warning signs. Yet studies have repeatedly shown that knowledge about rare fungal infections among nursing staff can be patchy, particularly in resource-limited settings where formal training on emerging pathogens may be scarce. The Egyptian research team recognized this gap and designed a quasi-experimental study to test whether targeted education could close it. They enrolled 81 pediatric oncology nurses at CCHE 57357, measuring their baseline knowledge with a structured questionnaire and their actual infection-control behaviors with an observational checklist completed at the bedside.

The educational intervention itself consisted of three structured sessions covering the risk factors for mucormycosis, its pathophysiology, and the infection control measures that nurses can implement in daily practice. This content was not exotic. It included fundamentals such as environmental hygiene, appropriate use of personal protective equipment, meticulous hand hygiene, safe food handling for neutropenic patients, and surveillance for early signs of infection. But the study’s design ensured that the effect of this teaching could be quantified. Every participant completed the same knowledge assessment before and after the program, and trained observers evaluated the same set of practices using the same checklist at both time points, allowing direct comparison of scores across the intervention.

The results were striking. The mean knowledge score nearly doubled, rising from 5.82 plus or minus 0.91 before the program to 12.1 plus or minus 0.76 afterward, a difference that was statistically significant with a p-value below 0.001. The mean practice score, reflecting what observers actually saw nurses do rather than what they claimed to know, climbed from 3.86 plus or minus 1.13 to 7.58 plus or minus 1.02, also highly significant. In other words, the training did not merely fill heads with facts; it changed hands-on behavior at the bedside. Nurses who had completed the sessions were demonstrably more likely to perform the preventive measures that the checklist captured, from environmental controls to protective equipment use.

Equally interesting was the relationship between knowledge and practice. The researchers found a positive correlation between the two at both time points: before the intervention, the correlation coefficient was 0.348 with a p-value of 0.001, and after the intervention it was 0.382 with a p-value below 0.001. This suggests that what nurses know is linked to what they do, and that strengthening knowledge may be a viable pathway to strengthening practice. The correlation is moderate rather than perfect, which is a familiar pattern in health-services research; knowing the right thing does not always translate into doing it, particularly under the time pressures and staffing constraints of a busy oncology ward. But the consistency of the association before and after training reinforces the case for education as a lever for behavioral change.

The authors are careful, and rightly so, about the limits of what their study can claim. Because the design was a one-group pretest-posttest study without a control group, and because patient outcomes were not tracked, the findings cannot be interpreted as evidence that the training reduced actual mucormycosis infection rates. No children were followed to see whether their risk of fungal infection declined. The improvements measured were in nurse knowledge and observed practice, over a short-term horizon, and the study cannot rule out other explanations for the change, such as heightened attention from being observed or the general effect of participating in a research project. These are standard caveats for this study design, but they matter for anyone hoping to translate the results into policy.

Nevertheless, the study carries real weight for a field that urgently needs practical solutions. Invasive fungal infections in pediatric cancer patients are associated with prolonged hospitalizations, expensive antifungal therapy, and significant mortality, and the arsenal of preventive tools is limited. Environmental measures and vigilant nursing care are among the few interventions available on the front lines, and they cost far less than new drugs. If a three-session educational program can nearly double knowledge scores and substantially improve observed infection-control behavior among nurses caring for the most vulnerable children, that is an intervention worth replicating and testing more rigorously. The Egyptian team’s work provides a template: a structured curriculum, validated assessment tools, and an observational checklist that other institutions could adapt.

The broader lesson extends beyond mucormycosis. As fungal infections gain prominence in global health discussions, driven by rising numbers of immunocompromised patients and growing awareness of fungal threats, the healthcare workforce’s preparedness becomes a critical variable. This study demonstrates that targeted, relatively brief professional education can move the needle on both knowledge and practice in a specialized nursing population. The authors call for continuous professional development and targeted training to sustain and build on these gains, a reminder that a single educational burst is unlikely to be enough. For the nurses of CCHE 57357 and the children they care for, the message is clear: understanding the enemy is the first step in defending against it, and that understanding can be taught.

Subject of Research: Effect of a structured educational program on pediatric oncology nurses' knowledge and mucormycosis-prevention practices

Article Title: Changes in pediatric oncology nurses’ knowledge and observed mucormycosis-prevention practices following an educational programme: a one-group pretest-posttest study

Article References: Changes in pediatric oncology nurses’ knowledge and observed mucormycosis-prevention practices following an educational programme: a one-group pretest-posttest study. (n.d.). https://doi.org/10.1186/s12912-026-05382-5

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05382-5

Keywords: mucormycosis, pediatric oncology, nursing education, infection control, fungal infection, chemotherapy, immunocompromised children, quasi-experimental study, Egypt, nurse training, knowledge and practice, BMC Nursing