Infections

Avoid & Prevent Infection Exposure

Avoiding and preventing exposure to infections is a daunting task that post blood stem cell patients live with every day of their lives. What people with healthy immune systems take for granted - a walk in the park with children playing, a visit to the local child's library, a party with friends who are inflicted with infection - Aplastic Anemia post-transplant patients guard against like a person guards against a gun going off haphazardly.

The single most critical responsibility that a post-transplant patient has is to do all he or she can to avoid being exposed to an infection or contagious disease and thus prevent contraction of the infection.

While this is not a complete list, here are some of the most critical actions recommended for preventing infection according to the Seattle Cancer Center.

See also: Sepsis, Septic Shock

CMV Monitoring means regular blood draws

CMV affects about 80% of the population. Most people don't know that they are CMV positive, because it usually doesn't cause issues, unless a person goes through some other process that affects their systems. Treatment prior to a transplant kills an immune system, which then is compromised for a lifetime, although much more so when steroids and other immunosuppressant drugs are taken (Prograf, tacrolimus, for example).

BMT patients are tested for CMV regularly.

You should be tested weekly if:

• You have EVER tested positive for CMV (referred to as CMV seropositive), and are on steroids, or
• You were treated for CMV prior to Day 100 (Day 100 is a major milestone day for BMT patients), or
• You were CMV negative, but were treated for CMV prior to Day 100.

CMV must treated immediately. You likely will have no symptoms at all of the CMV virus being active, but it will show up in lab tests.

CMV goes dormant, and can reactive at any time. There's no information in the research papers indicating what activates it; conversations have indicated that it has no cause for reactivition, it just does.

Avoid Exposure to infection

Avoiding crowds is the single most important action to take to avoid infection (hand washing is next in line). BMT patients should continue to avoid crowds during flu and cold seasons until their immune system is restored to the level that it will heal (until you are cured).

BMT patients should not go to schools where children are present at any time during the first year post transplant. The risk of contracting RSV is high in any school, but particularly high during cold and flu seasons.

Wash your hands habitually

If you want a habit, make it washing your hands. More viruses and bacteria are transferred on the hands than through any other mechanism. Wash your hands constantly.

Ask visitors to your home to wash their hands before touching anything or you.

Wear disposable gloves if you must do anything that exposes you to an infectious substance. Wear gloves to change diapers, then dispose of the gloves afterwards, and wash your hands after disposing of them. Do not clean up feces or vomit.

BMT patients should avoid being in close proximity (in the same house or dance area) with people who have a cold, flu or any other contagious infection. It is easier for a BMT patient to go to a store than to a family function because people don't touch everything at a store with their hands that have covered a cough or sneeze, but people tend to touch everything in a home, even if they have an infection. The contacts at a store are less than the contacts at a home.

Avoid exposure to Contagious Diseases

Avoiding crowds will help to avoid exposure to contagious diseases, but it doesn't end there. Be your own best advocate. Be on the watch, and advise people that you cannot be around people with any form of contagious disease. Do not go near anyone with a cold or flu, and never let them visit your home while they have the cold or flu or for three weeks after the initial symptoms.

chickenpox, zoster

BMT patients who are exposed to chickenpox or zoster (shingles) should immediately notify their BMT doctor. BMT patients are usually on Acyclovir medication, or a similar drug. If not, Varicella Zoster Immune Globulin (VZIG) should be taken within 48 hours (and at least within 96 hours) after an exposure to chickenpox or zoster.

BMT patients who notice chickenpox or shingles should immediately contact their BMT doctor. Hospital admission is likely; an IV of Acyclovir will likely be started immediately upon admission. Chickenpox and shingles are very dangerous.

Monitor Yourself for Skin Rashes - Report them

BMT patients who develop ANY form of rash should promptly notify their BMT doctor. Rashes can be insignificant, but they can also be a symptom of a much worse disease or infection. You don't want to risk it.

Take your Temperature - Record & report it

If your temperature is at 100.5 or above, contact your BMT doctor or medical team immediately. Report your symptoms, temperature and the date and time of the temperature.

Whenever you feel out of sorts, ill or as though you might have a fever or have a fever, take your temperature right away. Record the date, time and your temperature. If your temperature is below 100.5 degrees Fahrenheit, the rule of thumb says to notify your BMT doctor promptly, but if you feel ill, do so immediately.

Avoid Animals

BMT patients should never touch any excretions from any animal.

BMT patients should never sleep with an animal of any type.

For at least one year, or for as long as immunosuppressant drugs are prescribed, BMT patients should avoid contact with any new animals that were not part of the household where they lived prior to transplant.

Experts in BMT's recommend against bringing any new pet into the home for as long as the BMT patient is on immunosuppressant drugs. No new pets.

stay out of the dirt - don't garden

BMT patients cannot garden or work in dirt while on immunosuppressant drugs. Dirt contains numerous funguses and bacteria, and may contain viruses and other harmful materials. DO NOT exposure yourself to dirt.

BMT patients should never take walks in the woods, play in leaves, rake leaves, mow the grass, plant flowers, or dig in the dirt even with a shovel, even with gloves.

Don't Swim In Pools, Lakes - No hot tubs

Lakes, pools and hot tubs contain microorganisms that can cause deadly infections. BMT patients should not swim in pools - public or private, inland lakes or oceans, and should not go in anyone's hot tub including their own.

If swimming is necessary for prescribed exercise, swim in a private pool that is never swam in by anyone else, and ensure that it has been chlorinated properly.

• Never submerge your face in any pool, lake or hot tub regardless of the situation.
• Never swim with a central line.

Be Careful & Wise With Sexual Activity

All sexual activity should be limited to a partner who does not have any type of contagious disease or STD, both of which can cause life-threatening infections and disease in a BMT patient.

• Always practice safe sex.
• Always practice clean sex.
• Do not have sex with multiples of partners; it increases the risk of contracting deadly diseases and infections.

BMT patients should never use impotence drugs without having undergone cardiovascular testing, and after a consultation with their BMT doctors.

BMT patients with Chronic GVHD may experience painful or dryness issues. Use a lubricant and limit the sexual activity to those actions which do not cause pain.

References:

Patient & Caregiver Resource Manual For Adult Allogeneic Patients, Seattle Cancer Care Alliance, Long-Term Follow-Up Program, Dr. Fred Hutchinson