ORGAN TRANSPLANTATION

&
INFECTION PREVENTION
Dr.T.V.Rao MD

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

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

More Donations Today than in the Past

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

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

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

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

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

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 bodys immune
system response, it can also put
you at greater risk for fungal
infections.
Dr.T.V.Rao MD " TMC Kollam India

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

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

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Improving Infection Prevention

Outcomes

Hand Hygiene
remains the most
effective way to
decrease the
transmission of
infections
Dr.T.V.Rao MD " TMC Kollam India

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Improving Infection Prevention

Outcomes
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

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Improving Infection Prevention

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

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Of the many Infections Fungal Infections

can be More Dangerous
Fungal infections can range
from mild to lifethreatening. Some fungal
infections are mild skin
rashes, but others can be
deadly, like fungal
pneumonia. Because of this,
its important to seek
treatment as soon as
possible to try to avoid
serious infection.

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

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

15

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 patients

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

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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, youre more
likely to get these infections
than the general population.
For more information on
travel-related illnesses
Dr.T.V.Rao MD " TMC Kollam India

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

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

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

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

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

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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

Improving Infection Prevention

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

25

Improving Infection Prevention

Outcomes
Enteric Precautions:
Unexplained or suspected
infectious diarrhoea
Management of environment
essential
Cleaning /disinfection
Dedicated toilet/ commode/
equipment
C Diff
Norovirus
Acute hepatitis A
Dr.T.V.Rao MD " TMC Kollam India

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Improving Infection Prevention

Outcomes

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

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Improving Infection Prevention

Outcomes
Strict Precautions
(Isolation)
Creates a physical barrier
Gloves, gown and mask
(MRSA)
For staff and visitors
VRE
MRSA
Dr.T.V.Rao MD " TMC Kollam India

28

Strict Precautions (Isolation) Can change

the events on Infection

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

29

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

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Improving Infection Prevention

Outcomes
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

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

31

Improving Infection Prevention

Outcomes
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

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

32

Improving Infection Prevention

Outcomes
Staff:
Practice hand hygiene
Should be immunized
(hepatitis, influenza,)
Adherence to best
practice guidelines
Dr.T.V.Rao MD " TMC Kollam India

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Bacterial Survival times on hands

Acinetobacter spp
E. coli
Klebsiella spp
VRE
Pseudomonas spp
Rotavirus

11/10/2014

60 min
6 min (mean)
2 min (mean)
60 min
30 min; 180 in sputum
16% survive 20 min;
2% survive 60 min

Dr.T.V.Rao
Dr.T.V.Rao
MDMD
" TMC
@Health
Kollam
Care
India

34

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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

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

35

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
Dr.T.V.Rao
MDMD
" TMC
@Health
Kollam
Care
India

36

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

37

Collaborative Team Effort,

Support and
Communication Is The Key
Dr.T.V.Rao MD " TMC Kollam India

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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.)
11/10/2014

Dr.T.V.Rao
Dr.T.V.Rao
MDMD
" TMC
@Health
Kollam
Care
India

39

39

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

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

40

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

41

Good House Keeping Saves many

From Infections

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

42

Closer Communication between Microbiology

Department and Clinical care Provider

Close
communication
and monitoring by
health care team
and infection
prevention and
control
Dr.T.V.Rao MD " TMC Kollam India

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Health Team can Reduce Infections

The health care
team can help
ensure that
recovery is not
complicated by a
preventable
infections
Dr.T.V.Rao MD " TMC Kollam India

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Act as the Situation Warrants

11/10/2014

Dr.T.V.Rao
Dr.T.V.Rao
MDMD
" TMC
@Health
Kollam
Care
India

45

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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

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

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References
Infection Prevention And Control Transplant Atlantic 2011October
13/2011 Kathy Hart
APIC Text of Infection Control and Epidemiology: 3rd Edition: 2009
Google Images

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

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VISIT ME FOR MORE ARTICLES OF

INTEREST ON INFECTIOUS DISEASES

Dr.T.V.Rao MD

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

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