Reduce Your Risk of Infection
by Jeremy Young, MD, MPH
Many people with cancer have an increased risk of infection. This may be due to suppression of the immune system from cancer itself, chemotherapy and radiation used to treat malignancy, breaks in the skin at IV or surgical sites, or anatomic obstruction from a tumor. The good news is that, due to education, infection control efforts, and advancements in diagnostic and therapeutic options, the risk of infection 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.
The most important step is to wash your hands frequently with soap and water, particularly before preparing or eating food and after using the bathroom. You should also take the initiative to remind your healthcare providers to wash their hands before performing a physical examination, drawing blood, or changing the dressing on an IV line or wound. Even the best of us benefit from an occasional reminder.
At home, keep IV lines clean, dry, and dressed to help keep bacteria from entering these breaks in the most important protective barrier you have – your skin. I also suggest using an electric razor for shaving to help avoid cuts to the skin. Oral hygiene is another vital component to infection prevention, and my advice is to incorporate antiseptic mouthwash into your daily routine and use a soft toothbrush at least twice per day.
Taking some dietary precautions is another important component in preventing infections. Be sure to cook meat thoroughly to kill any microorganisms and wash all raw vegetables meticulously. If you are preparing foods that are potentially hazardous, such as raw chicken or shellfish, you should always be aware of cross-contamination. Do not use the same cutting board or counter space for raw meat and other foods unless you wash the surface with soap and hot water in between.
The most important step is to wash your hands frequently with soap and water.
Avoid eating raw or unpasteurized foods, such as sushi, oysters, steak tartare, and some soft cheeses. Well water, which can contain harmful parasites, is a potential source of infection that is often overlooked. Bottled or other treated water is a safer option when you are going through a period of immune suppression from cancer or chemotherapy.
People and Pets
Since infections are communicable diseases, loved ones can unfortunately be sources of infection. You should avoid contact with others who may have an infection, particularly during flu season. Some signs or symptoms to watch out for include fever, sore throat, cough, vomiting, diarrhea, or a rash. If contact is necessary, appropriate precautions should be taken, such as frequent hand washing and wearing a mask if the person is coughing.
Another potential friendly source of infection is pets. Always wash your hands after petting or grooming them, avoid handling animal waste or changing litter boxes, and try your best to prevent bites and scratches.
Outdoor activities are fun, and should not necessarily be avoided. However, some molds can be at particularly high concentrations in the environment, and you may be susceptible to infection if they are inhaled. During chemotherapy, you should avoid mowing grass, mulching, composting or other activities that can lead to the inhalation of airborne spores into your lungs.
Vaccines and Medication
Some vaccines can help prevent infections, and it is very important for all people with cancer and family members to have a yearly influenza 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 without precautions, as they can transmit virus used in the vaccine without becoming ill. Your physician will be aware of this.
Some other steps your physician may take to help prevent infections include prophylactic antibiotics and medications to stimulate production of white blood cells to help reconstitute your immune system. Those at very high risk for infection, such as people with prolonged neutropenia due to hematologic malignancies or chemotherapy, may require antibacterial, antifungal, or antiviral medications for prophylaxis against infection. We generally try to avoid overusing antibiotics due to growing numbers of resistant pathogens; however, when a person is severely immune compromised, the benefit may outweigh the risk.
Just remember, 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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Dr. Jeremy Young is an assistant professor of Medicine and Infectious Diseases at The Ohio State University Medical Center and Arthur G. James Cancer Hospital in Columbus, OH.
This article was published in Coping® with Cancer magazine, November/December 2008.