organ transplantation&infection prevention

ORGAN TRANSPLANTATION

&INFECTION PREVENTION

Dr.T.V.Rao MD

Dr.T.V.Rao MD " TMC Kollam India 1

Donating Organs is a Greatest Human Gift to some one ……..

•The gift of an organ is life changing for the patient who receives it.•The Door becomes immortal


More Donations Today than in the Past


Surgery and Infection

• In the past several years, the drugs that we use, the surgeries themselves, and infection control measures have improved outcomes for the solid organ transplant patient Despite these advancements, infections continue to have a substantial influence on patient outcome Many factors that influence infection risk are outside the scope of this presentation, which will focus on: fundamental infection control practices in relation to the adult solid organ transplant patient while in hospital


INFECTION CARRIES MAJOR RISKS IN ORGAN TRASPLANTATION

•As complications from infection are a major cause of morbidity and mortality following transplantation, infection prevention is a cornerstone of any modern solid organ transplantation program. There is no doubt that, among other measures, antimicrobial prophylaxis has decreased the incidence and severity of post transplant infections, and it is a major contributor to the currently improved survival rates of solid organ transplant recipients.Dr.T.V.Rao MD " TMC Kollam India 5

Microbiology Laboratory plays a Major Role in Infection Control

• The primary factors to consider in risk assessment and selection of precautions fall into two broad categories: agent hazards and laboratory procedure hazards. In addition, the capability of the laboratory staff to control hazards must be considered. This capability will depend on the training, technical proficiency, and good habits of all members of the laboratory, and the operational integrity of containment equipment and facility safeguards.


WHO GUIDES PROTOCOLS

• The World Health Organization (WHO) has recommended an agent risk group classification for laboratory use that describes four general risk groups based on these principal characteristics and the route of transmission of the natural disease.


CHALLENGES IN ORGAN TRANSPLANTATION

• As an organ transplant patient, you have new opportunities for a healthy and full life. You may also have some new health challenges. One of those challenges is avoiding infections. While anti-rejection medication helps your accept the new organ by lowering your body’s immune system response, it can also put you at greater risk for fungal infections.


Organ Transplant and Infection

• Organ Recipients at risk for nosocomial, opportunistic, and community-associated infection

• Type of transplant can be predictor of certain infections• Renal transplant: UTI• Liver transplant: abdominal infection• Heart and Lung: Pneumonia• 1-30 days post transplant ◦

Bacterial infections (device and procedure related)• ◦ Hospital Associated Infections (HAI)• ◦ Guidelines for best practice guide clinical practice

: Dr.T.V.Rao MD " TMC Kollam India 9

The Solid Organ Transplant (SOT) Patient

• The following may increase the risk of

• infection:

• ◦ Colonization of the respiratory tract with resistant bacteria

• or fungus ( Pseudomonas)

• ◦ Colonization of antibiotic resistant organisms associated

• with long hospital stay ( MRSA, VRE)

• ◦ Poor health prior to transplant

• ◦ Invasive procedures (surgery, devices)

• ◦ Degree of immunosuppression


Improving Infection Prevention Outcomes

•Hand Hygiene remains the most effective way to decrease the transmission of infections



• Admission Screening:

• ◦ SOT patients often come from other institutions

• ◦ Point of care opportunity to identify infection risk and initiate appropriate precautions

• ◦ ARO screening tool

• ◦ ILI screening Dr.T.V.Rao MD " TMC Kollam India 12


• Droplet Precautions

• ◦ Exposure zone is 6.6 feet

• ◦ Surgical mask/ face protection

• ◦ Contact precautions as necessary

• ◦ Single room preferred

• ◦ Influenza

• ◦ Mumps

• ◦ Invasive group A strep (<24 hours antibiotics)

• ◦ Meningococcal meningitis (< 24 hours antibiotics


Of the many Infections Fungal Infections can be More Dangerous

• Fungal infections can range from mild to life-threatening. Some fungal infections are mild skin rashes, but others can be deadly, like fungal pneumonia. Because of this, it’s important to seek treatment as soon as possible to try to avoid serious infection.Dr.T.V.Rao MD " TMC Kollam India 14

Fungal Infection can Mimic other Infections

• Fungal infections can look like bacterial or viral infections. If one is taking medicine to fight a bacterial or viral infection and one not getting better, think about testing for a fungal infection.


Fungal Infections Higher with Bowel Transplants

• Fungal infections may be more common in certain types of transplants. Some experts think that fungal infections may be most common in small bowel transplant patients, followed by lung, liver, and heart transplant patientsDr.T.V.Rao MD " TMC Kollam India 16

Where you live (geography) matters

• Some disease-causing fungi are more common in certain parts of the world. If you have had an organ transplant and live in or visit these areas, you’re more likely to get these infections than the general population. For more information on travel-related illnesses


Increased Stay Causes More Chances of Fungal Infections

• Hospital stay matters. After transplant, one may need to stay in the hospital for a long time. While there, one may need procedures that can increase chance of getting a fungal infection


Types of Healthcare-associated Infections

• Modern healthcare employs many types of invasive devices and procedures to treat patients and to help them recover. Infections can be associated with the devices used in medical procedures, such as catheters or ventilators.


Catheter Related infections in Transplant Patients

• These healthcare-associated infections (HAIs) include central line-associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated pneumonia. Infections may also occur at surgery sites, known as surgical site infections. CDC works to monitor and prevent these infections because they are an important threat to patient safety.


Fungal infections can happen any time after surgery.

• Fungal infections can happen any time after your surgery. Fungal infections can happen days, weeks, months, or years after the transplant surgery

• Fungal Infections are Difficult to Diagnose and Treat the Patients in the Post transplant Patietns


Common Fungal Infections • Some types of fungal infections

are more common than others in solid organ transplant patients. In the United States, invasive candidiasis is most common, followed by aspergillosis and cryptococcosis, but other types of fungal infections are also possible. For lung transplant patients, aspergillosis is most common


Preventing fungal infections in organ transplant patients

• Fungi are difficult to avoid because they are a natural part of the environment. Fungi live outdoors in soil, on plants, trees, and other vegetation. They are also on many indoor surfaces and on your skin. However, there may be some ways you to lower your chance of getting a serious fungal infection.Dr.T.V.Rao MD " TMC Kollam India 23

Protect oneself from the environment.

• Try to avoid areas with a lot of dust like construction or excavation sites.

• Stay inside during dust storms.

• Stay away from areas with bird and bat droppings. This includes places like chicken coops and caves.

• Wear gloves when handling materials such as soil, moss, or manure.

• Wear shoes, long pants, and a long-sleeved shirt when doing outdoor activities such as gardening, yard work, or visiting wooded areas. Dr.T.V.Rao MD " TMC Kollam India 24


• Influenza

• ◦ Most frequent cause of death from a vaccine preventable

• disease in the US

• ◦ In SOT patients, influenza infection has been implicated in

• allograft rejection

• ◦ SOT patients should receive influenza vaccination



• Enteric Precautions:• ◦ Unexplained or suspected

infectious diarrhoea • ◦ Management of environment

essential• ◦ Cleaning /disinfection• ◦ Dedicated toilet/ commode/

equipment• ◦ C Diff• ◦ Norovirus• ◦ Acute hepatitis A



• C Diff:

• ◦ Most common cause of infectious diarrhea in the

• hospitalized patient

• ◦ SOT patients have risk factors that increase susceptibility

• to CDI:

• Antibiotic use

• Low serum antibody response to toxin A

• Prolonged hospitalization

• ◦ Mattihas et al: Nephrology Dialysis Transplantation: 2004:19(10) : 2432-2436



• Strict Precautions (Isolation)

• ◦ Creates a physical barrier

• ◦ Gloves, gown and mask (MRSA)

• ◦ For staff and visitors

• VRE

• MRSA


Strict Precautions (Isolation) Can change the events on Infection


Airborne Precautions Improving Infection Prevention Outcome solutions

• Airborne Precautions:• ◦ Negative pressure ventilation in room• ◦ Staff: fit tested N95 respirator* • Active pulmonary TB• Disseminated shingles • Varicella• Measles• ◦ The immunocompromised patient is at risk for TB and disseminated • shingles• ◦ Latent TB may be reactivated in the immunocompromised



• The Environment: is rarely a infection risk to immunocompetent patients

• ◦ A risk to the immunocompromised

• ◦ Environmental opportunistic pathogens

• Aspergilla• Legionella• In addition to general cleaning

and disinfection: construction/renovation must be monitored any water damage/leaks reported



•Cleaning and general housekeeping of the unit with as little dust production as possible

• Bottled water policy

• Fresh flower policy

• Identify the Areas for effective Disinfection



•Staff:

• Practice hand hygiene

• Should be immunized (hepatitis, influenza,)

• Adherence to best practice guidelines


34

Bacterial Survival times on hands• Acinetobacter spp 60 min

• E. coli 6 min (mean)

• Klebsiella spp 2 min (mean)

• VRE 60 min

• Pseudomonas spp 30 min; 180 in sputum

• Rotavirus 16% survive 20 min;

2% survive 60 min

11/10/2014 Dr.T.V.Rao MD @Health CareDr.T.V.Rao MD " TMC Kollam India 34

Role Of Infection Prevention and Control

• Hand hygiene audits• Environmental audits• Equipment procurement• Oversee construction/renovation:

CSA guidelines• Targeted surveillance• ◦ Bacteraemia• ◦ ARO (MRSA, VRE, ESBL)• ◦ Pneumonia (ICU/IMCU)• ◦ SSI• ◦ C difficle infection


Infection Control Program

• A comprehensive, effective and supported program is essential for reducing infection risk and increasing hospital safety.

• It should include surveillance, preventive activities and staff training.

11/10/2014 Dr.T.V.Rao MD @Health Care 36Dr.T.V.Rao MD " TMC Kollam India 36

Role Of Infection Prevention and Control

• Surveillance Data:• ◦ Collected using standard

definitions• ◦ Canadian Nosocomial Infection

Surveillance • Program (CNISP) provides

benchmarks• ◦ Infection rates are provided to

the health care teams on the unit• Outbreak Management• Education and Consultant


Collaborative Team Effort, Support and

Communication Is The Key


HAND WASHING

+Hand washing is the single most effective precaution for prevention of infection transmission between patients and staff.

+Hand washing with plain soap is mechanical removal of soil and transient bacteria (for 10- 15 sec.)

+Hand antisepsis is removal & destroy of transient flora using anti-microbial soap or alcohol based hand rub (for 60 sec.)


Team Collaboration• C diff activity: Transplant Unit

• ◦ Increase in lab confirmed cases (6 cases in 5 weeks)

• ◦ Infection control investigation initiated

• ◦ Pts moved to private rooms

• ◦ Environmental cleaning enhanced


Best House Keeping Practices Reduces Infections

• ◦ Housekeeping initiated enteric cleaning ( 2 step: ultraquat followed in 10 min with dilute javex other Antiseptics )

• ◦ Enteric measures initiated on all patients with unexplained diarrhoea

• ◦ Lab saved specimens to be typed


Good House Keeping Saves many From Infections


Closer Communication between Microbiology Department and Clinical care Provider

•Close communication and monitoring by health care team and infection prevention and control


Health Team can Reduce Infections

•The health care team can help ensure that recovery is not complicated by a preventable infections


Act as the Situation Warrants


Simple Practice of Infection Prevention have Greater contributions than many Matters

• The Organ Donor and Recipient Programs are associated greater challenges than in the past with aggressive immunosuppressive therapy and effective Diagnostic Microbiology Services will Reduce Morbidly and Mortality

• However simple practice of Infection Prevention has to be adhered for successful outcome

The world is Awaiting many Donors to Save many In the World


References • Infection Prevention And Control Transplant Atlantic 2011October

13/2011 Kathy Hart

• APIC Text of Infection Control and Epidemiology: 3rd Edition: 2009

• Google Images


VISIT ME FOR MORE ARTICLES OF INTEREST ON INFECTIOUS DISEASES

Dr.T.V.Rao MD 49

•Program Created By Dr.T.V.Rao MD for benefit of Many who work in the Human Organ

Transplantation Program

•Please contact for queries and suggestions Dr.T.V.Rao MD

Professor of Microbiology

Mob +918281669524


organ transplantation&infection prevention

Health & Medicine

rao md tmc kollam india1

rao md tmc kollam india2

rao md tmc kollam india3

rao md tmc kollam india4

rao md tmc kollam india5

rao md tmc kollam india6

rao md tmc kollam india7

rao md tmc kollam india8