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Reduce Your Risk of Infection

by Jeremy Young, MD, MPH

Having cancer can increase your risk of some infections. Susceptibility to infection can be influenced by the suppression of immune function from chemotherapy or radiation; low white blood cell counts from the cancer itself; disruption of the skin or mucous membranes at IV sites, surgical sites, or from other invasive procedures; or anatomic obstruction from a tumor. The good news is, due to education, more aggressive infection control efforts, vaccination, advancements in diagnostic and therapeutic measures, medications to help re-establish the immune system, and the prudent use of preventive antibiotics, the risk of infection in people with cancer has decreased significantly over the past few decades. In fact, by following a few simple rules, you have the power to greatly reduce your risk.

Personal Hygiene
The most important barrier against infection is clean, intact skin. Wash your hands frequently with soap and water, or use an alcohol-based hand sanitizer, particularly before and after preparing or eating food and after using the bathroom. You should take the initiative to remind your healthcare providers to wash their hands before performing a physical exam, changing dressings, drawing blood, inserting an IV line, or performing other procedures. Even the most meticulous healthcare professionals benefit from an occasional reminder.

At home, do your best to keep dressings over IV lines and surgical sites clean, dry, and intact to help keep bacteria from entering these breaks in your skin. If shaving is necessary, use an electric razor instead of a blade to minimize abrasions or cuts to your skin. Oral hygiene is another important component in preventing infections. Brush your teeth with a soft toothbrush at least twice daily, use floss, and incorporate antiseptic mouthwash into your daily routine.

The most important barrier against infection is clean, intact skin.

Food Safety
If you have a compromised immune system from cancer or chemotherapy, it is vital that you practice some dietary precautions. First, be sure to cook meat thoroughly, and avoid eating raw or unpasteurized foods, such as sushi, oysters, steak tartare, raw milk, and some soft cheeses. Wash all raw vegetables before you eat them. Also, do not use the same cutting board or counter space for raw meat and other food preparation unless you wash the surface with soap and hot water in between. Some particularly hazardous foods that are known to transmit pathogens include raw chicken, ground beef, and shellfish.

Always know the source of your drinking water. Well water can contain harmful parasites and is often overlooked as a potential starting point of infection. Bottled or other treated water tends to be a safer option when you are going through a period of immune suppression from cancer or chemotherapy.

People and Pets
Many infectious diseases are contracted from others, including loved ones. You should avoid direct contact with other people who may have a communicable disease, particularly during flu season. Some important signs and symptoms to ask about include fever, sore throat, cough, vomiting, diarrhea, and a rash. If you must be in close proximity, always have family and friends use appropriate precautions, such as frequent hand washing and wearing a mask if the person is coughing.

Another friendly source of infection can be pets. Always wash your hands after close contact with pets, avoid handling animal waste or changing litter boxes, and do your best to prevent bites or scratches.

Avoiding Mold
The great outdoors can contain high quantities of mold spores, particularly during certain times of the year. Outdoor activities are fun, and shouldn’t necessarily be avoided. However, during chemotherapy, or other times when your immune system is not at its strongest, inhaling mold spores into your lungs can increase your risk of serious fungal infection, so it’s best to avoid activities that can stir up mold in the air, such as mowing grass, trimming bushes, mulching, or composting.

Vaccines and Preventive Antibiotics
Vaccines have been vital in the battle to prevent serious infections. They can be lifesaving, particularly in people with cancer. It is very important for you and your family members to have an annual flu vaccine. However, you should always talk to your physician (who will take your level of immune suppression into consideration) before receiving vaccines. While many are safe, others contain live organisms and should be avoided in people undergoing chemotherapy. Some live vaccines should not be given to family members or other household contacts either, as they can transmit the virus used in the vaccine, even without the person becoming ill. Consult your physician, who will be aware of the risk of receiving vaccines.

The introduction of preventive antibacterial, antifungal, and antiviral medications has decreased the risk of infection significantly. Those at very high risk for infection, such as people with prolonged neutropenia, may benefit from receiving antibiotics during a time of clinical wellness in order to prevent an infection. We generally try to avoid overusing antibiotics due to the increasing prevalence of drug-resistant pathogens; however, when a person is severely immune compromised, the benefit often outweighs the risk.

Preventing infections is largely under your control. It is empowering to have such a large impact on an important part of your care, so take charge of preventing infections.

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