Safe Living Practices For Solid Organ Transplant Patients

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					Safe Living Practices For
 Solid Organ Transplant

  The Johns Hopkins Hospital
     Transplant Infectious
       Diseases Service
Factors Which Determine Your
       Risk of Infection
 How immunosuppressed are you?
 – Greatest risk for infection is during the first 6
   months after transplant and anytime you are
   treated for rejection
 – What type of anti-rejection medication are you
   taking and how much?
 Invasive procedures or tests
 Exposures in the hospital or in the
     Important Message

Prevention of infection should be
tailored to each transplant patient by
their physician with consideration of how
immunosuppressed they are and their
personal circumstances
  I. Prevention of Infection
Transmitted by Direct Contact
 Most organisms are acquired through direct
 contact (carried on hands) or inhalation
 Frequent and thorough hand washing—
 antimicrobial soap and water or hygienic hand
 Wear gloves when handling heavily
 contaminated materials such as soil, moss or
 Avoid going barefoot
 Hand Washing (including after
      gloves are used)
Before eating or preparing food
After touching pets or animals
After gardening, touching plants or soil
After changing diapers
After touching secretions or excretions or items that
have been in contact with human or animal feces
(eg. bedpans, bedding, toilets, litter boxes)
Before and after touching wounds or mucous
  II. Prevention of Infection
Transmitted by Direct Contact

Shoes, socks, long pants and long sleeved shirts
should be worn while doing yardwork,
gardening, farming or being in parks or wooded

Use insect repellant and avoid outdoor
exposures at dawn and dusk to prevent
exposure to West Nile virus, during the summer
and early fall in areas of possible transmission
I. Prevention of Respiratory
Transmitted by inhaling organisms or by
direct contact with contaminated hands to
mucous membranes
Frequent and thorough handwashing
Avoid close contact with people with
respiratory illnesses. If unavoidable, both the
transplant recipient and sick contact should
wear surgical masks
II. Prevention of Respiratory
Avoid crowded areas: shopping malls, subways,
elevators, during flu season and when highly
Avoid tobacco smoke—primary and secondary
Avoid smoking marijuana (Aspergillus)
Avoid potential exposure to tuberculosis: known
people with TB, avoid working in prisons, jails,
homeless shelters, certain health care settings
 Avoid Exposure to Environmental
Molds (Aspergillus) and other Fungi

 Avoid construction or excavation sites
 Avoid exposure to soil, fertilizer, decaying
 vegetation including compost heaps
 Avoid gardening and farming at least during the
 first year after transplant
 If unavoidable, wear a mask
 Avoid plant and soil aerosols, pigeon and other
 bird droppings, chicken coops, and caves
I. Water Safety - Cryptosporidium

 Cryptosporidium is uncommon in transplant
 No recommendation to avoid tap water
 Boiling water for 1 minute is the only way to
 eliminate the risk entirely
 If avoid tap water, need to realize that tap water
 is used at restaurants, movie theaters etc
 Select appropriate filters and/or bottled water
          II. Water Safety

Avoid well water from private or public wells
where it is checked infrequently for bacterial

Do not drink water directly from lakes or rivers

Avoid water that is likely to be contaminated
with human or animal waste

Avoid swallowing water during swimming
                 Food Safety:
           Choose the healthier options
Higher Risk                     Lower Risk
   Raw or undercooked meat or     Meat/pultry cooked safely
   poultry                        Smoked fish/seafood heated to
   Raw or undercooked fish        to 165 degrees
   Smoked fish                    Canned fish/seafood
   Precooked seafood              Seafoodcooked to 145
   Unpasteurized milk             Use pasteurized eggs/egg
   Foods with raw eggs
                                  Cooked sprouts
   Raw sprouts
                                  Washed fresh vegetbles
   Unwashed fresh vegetables
                                  Hard cheeses, processed
   Soft cheeses from
                                  cheeses, cream cheese
   unpasteurized milk
                                  Hot dogs, lunch meats that are
   Hot dogs, deli meats
                                  reheated to 165
   Unpateruized pates
                                  Canned pates
          I. Food Safety
Avoid drinking or eating food made with
unpasteurized milk
Avoid drinking unpasteurized fruit or vegetable
juice/cider (E coli O157:H7, Salmonella,
Brucella, Listeria, Yersinia, Cryptosporidium)
Avoid eating raw or uncooked eggs, including
food containing raw eggs (eg. uncooked cake
and cookie batter, some preparations of Caesar
salad dressing, homemade mayonnaise or
hollandaise sauce)
          II. Food Safety
Avoid eating raw or uncooked meat, poultry
or fish
Avoid all raw or undercooked seafood
(oysters, clams, mussels → Vibrio, viruses
that cause gastroenteritis, hepatitis,
Avoid raw seed sprouts (alfalfa sprouts, mung
beans→E.coli O157:H7)
Avoid raw green onions (hepatitis A)
           III. Food Safety
Avoid soft cheeses (feta, brie, camembert) or cheese
made with unpasteurized milk (listeriosis)
Fruits and vegetables should be peeled or very
thoroughly washed
Avoid open salad bars
Try to reheat deli meats, hot dogs, and turkey franks
if possible (listeria)
Reheat leftovers to steaming hot (165ºF)

Avoid food left over from community picnics or buffet
          Animal Contact

Occupation risk: veterinarians, pet store
employees, farmers, slaughterhouse or
laboratory workers

-Avoid working during maximal

-Handwashing, gloves, masks
            I. Pet Safety
Avoid stray animals

Avoid animal scratches

Avoid cleaning bird cages, litter boxes, animal
feces. If this is not possible, use disposable
gloves and a mask

Avoid contact with reptiles (snakes, iguanas,
lizards, turtles), chicks, ducklings (risk of
           II. Pet Safety

Wear gloves to clean acquarium

Avoid contact with non-human primates

If you have a pet, keep it healthy

Avoid pets who have diarrhea

Cats can spread Toxoplasma,
Cryptosporidium, Salmonella, Campylobacter
(contaminated feces) and Bartonella (fleas
and scratches)
Avoid acquiring cats that are less than 1 year
of age-more likely to be infected
Change litter boxes daily (preferably not by
the transplant recipient)
   Safe Sexual Practices
CMV, Hepatitis B and C, HIV, HSV are
sexually transmitted

Always use condoms when not in long-term
monogamous relationships

Consider using condom with long-term
partner during periods of increased

Avoid exposure to feces
          Travel Safety
Travel to developing countries poses
substantial risk, especially during the
first 6 months
Discuss travel plans with transplant
provider at least 2 months prior to
Updated travel advisories:
Food to Avoid in Developing
Tap water, ice and beverages made with tap
Fresh fruit juices
Unpasteurized mild and dairy products
Raw fruits and vegetables
Raw or undercooked meat, poultry, fish, and
Raw or undercooked eggs
             Travel Tips

Ingest fruits and vegetables that can be
Ingest foods that have been cooked to
steaming hot temperature
Drink bottled and canned processed drinks
Boil tap water or disinfect with iodine or
portable filters
             Travel Tips

Take antibiotics with you in case you get
traveler’s associated diarrhea

Malaria prophylaxis, if indicated

Check immunization status
   Immunizations (Vaccines)
Vaccines/boosters pre transplant
Avoid post transplant: live attenuated vaccines
Precautions in family members
– Oral polio can be shed and transmitted
– Varicella okay except if the person gets a rash, cover
  the rash
– Rotavirus (babies) shed day 1-15 after 1st dose
– MMR no transmission
– Live influenza nasal: avoid if severe
  immunocompromized, get injection instead
– Oral typhoid okay but shed: handwashing
– Smallpox contraindicated