Managing Life and Infections After Hematopoietic Stem Cell Transplantation
Infection Prevention
-
Why It's Important to
Avoid Infections -
How to
Prevent Infections -
Caring for Your
Hickman Catheter - Caring for Your Port
-
Getting Vaccinated
After a Transplant -
Bone Marrow
Transplant
(BMT) Clinic
Why infection prevention is crucial?
The lifespan of white blood cells is 7 to 14 days, and their crucial role is to resist infections and protect the body. If the number of white blood cells in the blood decreases, the body's defense against bacteria weakens, and the ability to fight infections diminishes, increasing the risk of infection. After cancer treatment, you may feel "chilly" or experience a fever. You can use antibiotics after testing to confirm if there is an infection. Cooperation from everyone who comes into contact with the patient and the patient's own management are necessary to prevent infections.
▲ Symptoms such as chills and fever
What are the methods for infection prevention?
Handwashing
- As many germs live on our hands, it's important to wash your hands thoroughly, especially before meals, after going out, and after using the restroom. When washing your hands, use running water and soap, and make sure to clean between your fingers, under your nails, and the tips of your fingers particularly well.
Oral care
- To avoid injuring your mouth, use a soft-bristled toothbrush when brushing your teeth. Brush your teeth four times a day - after each meal and before going to bed. After using, rinse your toothbrush thoroughly under running water and ensure it's completely dry before using it again.
Shower
- Normal flora live on our skin and can cause infections when immunity is compromised. Therefore, shower every 2-4 days. Avoid scrubbing your skin too hard, especially in areas where wrinkles form such as the armpits, the groin, and behind the knees.
Rectal care
- If you have wounds such as hemorrhoids, taking a sitz bath can be beneficial.
Hand and foot care
- Keep your fingernails and toenails trimmed, but not too short, to avoid injuring your skin. Make sure to wear shoes and socks to prevent wounds.
Shaving
- To prevent injuries while shaving, consider using an electric razor.
Skin care
- Avoid popping pimples or blisters on your skin with your hands to prevent inflammation and potential infection.
Avoid contact with infectious diseases
- Avoid contact with individuals who have a cold or contagious disease to prevent infection.
Consulting with one's doctor
- Discuss any vaccinations or dental treatments with your primary care physician before proceeding.
Cleaning things up
- It's advisable to remove items that may harbor infection risks (such as curtains, carpets, potted plants, and pets).
Mucous membranes of the nose and ears
- Avoid frequently touching or picking your nose and ears.
Hickman Catheter Insertion/Removal Site Care Guidelines
Required Materials
- Two single-use disinfectant swabs (Hexicol), one Opsite (or one Medress, if a non-woven fabric is preferred).
Guidelines
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1.
Clean hands thoroughly before disinfection.
-
2.
Slowly remove the attached Medress or Opsite (or Tegaderm), being careful not to pull on the catheter. Check the insertion site for any abnormalities (redness, pus or bleeding, pain).
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3.
Using a Hexicol stick, disinfect by drawing circles from the center outwards for at least 10 seconds, repeating this at least three times (one stick per 10 seconds).
- Avoid re-wiping areas already cleaned, and clean a diameter of 10cm. Do not re-dip or reuse a swab once used, and do not use it if it has fallen or touched clothing.
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4.
Once the disinfectant is completely dry, attach the Opsite (or Tegaderm) or Medress.
- Suture removal after catheter removal: Visit the injection room of the hematology hospital one week to ten days after catheter removal to remove the 'suture'.
- Until the Hickman catheter is removed, please have the Hickman catheter disinfected and the heparin solution exchanged and injected in the injection room of the hematology hospital when you visit the outpatient clinic (once a week or once every two weeks).
Port Insertion/Removal Site Care Guidelines
Guidelines
-
1.
An implanted port is inserted under the skin and does not have an exposed area outside the skin, so no separate disinfection is needed.
-
2.
If you have an implanted port, heparin solution should be injected if the port is not used for more than 4 weeks to prevent blockages. Please visit the injection room of the hematology hospital to have the heparin solution exchanged and injected at intervals of 4 weeks when you visit the outpatient clinic.
- Suture removal after port removal: Visit the injection room of the hematology hospital one week to ten days after port removal to remove the 'suture'.
Post-Transplant Vaccinations
Hematopoietic stem cell transplantation is a process where harmful stem cells are removed and replaced with healthy ones. Similar to a newborn baby, vaccinations are required to fight off various infectious diseases until the immune system is fully restored.
Vaccinations are not only effective in preventing the advancement of diseases, but they also improve the quality of life for patients by reducing the need for unnecessary antibiotics. Therefore, vaccinations are truly important. The schedule for these vaccinations is coordinated by both a hematologist and an infectious disease expert, taking into account the status of immune system recovery and the presence of any graft-versus-host disease. Hence, it's advisable to adhere to your primary care doctor's guidance and seek treatment from the infectious disease department as needed.
BMT Clinic (excluding autologous hematopoietic stem cell transplant patients)
Complications that can occur after allogeneic hematopoietic stem cell transplantation have common characteristics: they are hard to predict, and once they happen, they can be difficult to treat. These complications can significantly lower the quality of life after the transplantation, which highlights the importance of early detection and treatment. To address this, the Catholic Blood Hospital has established a BMT clinic. This clinic provides specialized and systematic treatment and care for patients who have undergone allogeneic hematopoietic stem cell transplantation. Clinic visits are crucial for managing potential complications post-transplantation, in addition to the treatment provided by the respective disease specialists. These visits help monitor the recovery of immune and physical functions after transplantation. The specific schedule and details of the treatment are as follows.
Schedule (based on the date of hematopoietic stem cell transplantation)
- Transplantation day ~ 1 year Every 3Months / ex: 3 months, 6 months, 9 months, 12 months (1 year)
- 1 year ~ 5 years: Every 6 months Every 6 months / ex: 18 months, 24 months (2 years), 30 months, 36 months (3 years), 42 months, 48 months (4 years), 54 months, 60 months (5 years)
Treatment details
- Examination Evaluation for early diagnosis related to acute and chronic graft-versus-host disease, observation for other complications
- Tests Virus antigen and antibody tests, inflammation index tests, immune recovery tests (cellular immunity and humoral immunity)
- Functional tests Pulmonary function tests, hormone tests, and various function recovery related questionnaires
- Request for consultation Referral for consultation with specialists in related departments (Ophthalmology, Dermatology, Otorhinolaryngology, Obstetrics and Gynecology, Endocrinology)