Nancy L. Stitt, RN, BSN

Disclosures

April 03, 2003

Treatment of Opportunistic Infection

While various treatment modalities have been described for opportunistic infection, attempts at prevention must precede treatment. Some common sense measures regarding the physical environment of the transplant recipient can logically make a positive impact on morbidity and mortality. The nursing profession has a long legacy regarding this important point. Florence Nightingale is credited with decreasing mortality from 42.7% to 2.2% at the Scutari Hospital near Constantinople in the Crimean War through sanitary reforms.[45] According to Nightingale, ". . . the greater part of nursing consists in preserving cleanliness."[46]

Hospitals, and ICUs in particular, harbor many potentially pathogenic organisms. In surgical ICUs, where transplant recipients are likely to be cared for in the immediate postoperative period, critical care nurses and physicians frequently come in direct contact with blood, pulmonary secretions, surgical drainage, feces, and urine. In addition to diagnostic equipment, these fluids serve as vectors (usually by the hands) for transmission of organisms from patient to patient.

The early approach to protecting the transplant patient from infection was the use of protective or reverse isolation. Contact with hospital personnel and family members was severely restricted, and anyone entering the patient's room was clothed in a sterile gown and gloves, disposable cap, mask, and shoe covers. All equipment entering the room was wiped down with an antiseptic solution, as was the floor every 8 hours. It was the critical care nurse's responsibility to maintain this standard. All linen was sterilized and meals arrived on disposable, sterilized trays. However, this elaborate, time-consuming, and expensive approach was not proven to be efficacious.

Today, with the recognition that many opportunistic infections are caused by latent or other internal organisms, a clean, but not sterile, environment and frequent hand washing are cornerstones of care of the organ transplant recipient. There is an emphasis on keeping clean and maintaining the integrity of skin and mucous membranes, limiting the number and duration of invasive devices, and providing optimal nutritional and metabolic support. And last, but certainly not the least important, immunosuppression regimens continue to be modified in an attempt to minimize toxic effects.

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