Lung Transplant: Preventing Infection at Home
After transplantation, your immune system is weak and you are at risk for infection. Unfortunately, the same medications that help prevent transplant rejection also cause you to be more susceptible to infections, particularly infections of the lungs and urinary tract.
You are extremely vulnerable to illness right after your transplant, when the levels of immunosuppressive drugs are at their highest. Even though your white blood cell count may be "normal," infections can still occur. Because the risk for infection continues long after you are discharged from the hospital, it is important to take steps to prevent infection at home.
What can I do to prevent infections once I leave the hospital?
- Limit visitors at first.
- If visitors have cold or flu symptoms, ask them to return when they are feeling well.
- Before visiting with an infant or child, check with the transplant team.
- Keep your house clean and free of excess dust.
- Do not work in or visit any form of construction site. Dust can be harmful. If you absolutely must go near this type of area, always wear a mask.
Activities and exercise
- Avoid gardening, mowing, mulching or planting for 1 year. After 1 year, you may garden, but you must wear gloves and a mask. Stay inside while your yard is mowed.
- Exercise. Walking helps to expand the lungs and strengthen your body. Ride an exercise bike if you have one at home. Check with the transplant team before doing any advanced exercising such as aerobics and weight lifting.
- Enjoy spending time with your pets, but decrease close exposure to them. Have other family members or friends clean the litter box, cage, or yard. In addition, do not add any new pets to your home, especially birds.
- Ask your health care provider when you can safely return to work or school.
- Try to eat a balanced diet. Good nutrition is important to help the body resist infection. Eat foods from all the food groups.
- Drink plenty of fluids. Water, juices, and sports drinks are best.
- Frequently wash your hands with soap and warm water, especially before preparing food, and after using the bathroom or touching soiled linens or clothing.
- Shower or bathe daily, using a mild soap. Special soap is not needed at home.
- If you have dry skin, apply a mild skin lotion after bathing.
- Examine your mouth and gums daily. If you have red or swollen gums for more than two days, contact your transplant coordinator. Red and swollen gums are common side effects of the immunosuppressive medication cyclosporine (Sandimmune® or Neoral®).
- Brush your teeth and gums thoroughly after each meal with a small, soft toothbrush and fluoride toothpaste. Use foam sticks instead of a toothbrush if your gums are especially sore.
- Use dental floss daily.
- Your doctor may tell you to use an antibacterial mouth rinse. Avoid commercial mouthwashes or lozenges, which contain a high concentration of alcohol. They may irritate or dry your mouth.
- Keep dentures clean and fitting properly.
- Be sure to have a routine check up and cleaning by your dentist at least every 6 months. Before your appointment, tell your dentist that you have had a lung transplant so that precautions can be taken to prevent possible infection. It is not necessary for you to obtain antibiotics prior to the dental procedure, unless you have heart ailments.
- Protect your skin from scratches, sores and other irritations that might lead to infection. If you have a cut (even if it's small), clean the area well with soap and water or hydrogen peroxide. Dry your skin and cover the cut with a sterile bandage.
Other medical precautions
- Record your temperature once a day. If your temperature is over 100°F, call your health care provider, since fever is an early sign of infection.
- Check your neck, armpits and groin area for lumps or new growths. Report signs of these to your doctor.
- Get the pneumonia vaccine if you have not had it.
- Women should perform monthly breast self-exams. Women should also have a pelvic exam with Pap smear and a mammogram every year, regardless of age.
- Men should have their PSA (prostate-specific antigen) and prostate checked every year.
- Get a flu shot every year. You cannot get the flu from receiving the shot itself.
What situations should I avoid?
- Do Not go into crowded areas for three months. If you cannot control how far away you can stay from other people, it is probably a crowd.
- Do Not use hot tubs, whirlpools, saunas or steam baths. Germs tend to multiply in these environments.
- Stay Out of the sun, unless you are wearing sunscreen. We recommend that you use a lotion with a SPF rating of 15 or above.
Additional precautions for preventing infection
- It is always safest to avoid raw or undercooked meat, eggs or seafood, which can transmit a variety of infections. Soft cheeses may transmit an infection known as Listeria and should be avoided. Hard cheeses and pasteurized products do not carry this risk.
- Whenever excessive exposure to dust or soil is anticipated, such as prolonged exposure to a construction site, a mask can be helpful to reduce the chance of inhaling fungal spores. Gardening (handling dirt, fertilizer, compost) and active farming are best left to other family members, if possible. However, a transplant recipient can certainly sit outside and enjoy the outdoors, take walks, etc.
- It is best to avoid direct contact with someone who is actively coughing and sneezing, however the common cold generally does not cause harm. Therefore, transplant patients should not quarantine themselves from family and friends; for example, during the winter months.
- Early attention for a fever or anything more than a simple cold is important, because early treatment may prevent a more significant infection. Your transplant team will likely recommend vaccinations, although they do not work as reliably after transplant. When you get a vaccination, you will be given only killed vaccines, not live virus vaccines. (Avoid oral polio, measles/mumps/rubella vaccines.)
- If you have had chickenpox in the past, you are protected lifelong. If you have never had chickenpox, your transplant clinician will likely check a blood test to see if you have had it without knowing it. If your blood shows you have never had it, you should avoid exposure to people with chickenpox or shingles. If such exposure occurs, you should receive preventive treatment.
- Infants in your household who are receiving their initial vaccinations should receive the inactivated polio shot rather than the live oral polio vaccine. It is best to tell the pediatrician in advance.
- If you plan to travel, especially overseas, consult with your transplant team. The team may recommend precautions, such as a visit to a travel clinic or an infectious disease specialist. Depending on the circumstances, the transplant team may suggest that you do not travel at this time.
- If a physician outside of the transplant team wants to start you on a new medication, even an antibiotic, ask the physician to notify the transplant team. Some medications can interact with the ones you are already taking and may lead to rejection or other side effects.
- Never be afraid to ask questions.
- Avoid second-hand smoke. Do not allow smoking in your home or car.
- Do not be so alarmed by all of this that you cannot enjoy life. With a few simple precautions, transplant recipients can lead very normal lives. Go out and do fun things. You do not have to wear a space suit or live in a bubble; however, a healthy awareness of the possible infection risks can go a long way toward minimizing the risk.
When should I call my doctor?
Call your doctor if you experience any of the warning signs of an infection (listed below).
Warning signs of infection
Although most infections can be successfully treated, you must be able to recognize an infection's immediate symptoms for proper and effective care. Warning signs include:
- Fever over 100°F(38°C)
- Sweats or chills
- Skin rash
- Pain, tenderness, redness or swelling
- Wound or cut that won't heal
- Red, warm or draining sore
- Sore throat, scratchy throat or pain when swallowing
- Sinus drainage, nasal congestion, headaches or tenderness along the upper cheekbones
- Persistent dry or moist cough that lasts more than two days
- White patches in your mouth or on your tongue
- Nausea, vomiting or diarrhea
- Flu-like symptoms (chills, aches, headache or fatigue) or generally feeling "lousy"
- Trouble urinating: pain or burning, constant urge or frequent urination
- Bloody, cloudy, or foul-smelling urine
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 11/15/2006...#4508