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Posted on 17. August 2017

A Little Infection Control Goes a Long Way

By Barbara Vujaklija, RN

How to Protect Yourself from Infection While Immunosuppressed

Many medications taken for autoimmune diseases are intended to suppress the immune system, in some cases leaving people vulnerable to infections from microorganisms. The extent to which patients need to protect themselves depends on a variety of factors, including which medications are taken and at what doses, how long the medications have been prescribed, where patients live and what facilities they have available, and many individual factors that patients can only determine with their doctors.

The following recommendations are for patients with extremely compromised immune systems due to medication/therapy. Each patient’s situation may be different, so a doctor should be consulted concerning which precautions are appropriate. In addition, patients should remember that these recommendations may change as medications are tapered or raised.

Washing Hands

The single most important thing patients can do to stop the spread of infection is hand washing. As a nurse, I taught the Center for Disease Control and Prevention’s course titled “When and How to Wash Your Hands” to staff members and others in the local community as part of my duties as an infection control nurse. First, a moment of myth-busting:

  1. Hot water is not needed to clean hands; it’s the friction of rubbing hands together that dislodges germs. No one’s skin could tolerate the temperature needed to sterilize hands.
  2. Antibacterial soap is not needed. In fact, it’s a bad idea because it kills weak bacteria, leaving room for strong ones to overgrow.

To properly wash hands, wet hands with clean, running water (warm or cold), turn off the tap and apply soap. Lather hands by rubbing them together with the soap. Be sure to lather the backs of hands, between fingers and under nails. Scrub hands for at least 20 seconds. This is the time it takes to hum the “Happy Birthday” song from beginning to end twice. Rinse hands well under clean, running water. Dry hands using a clean towel, or air dry them.

Wash hands before, during and after preparing food; before eating food; before and after treating a cut or wound; after using the toilet; after changing diapers or cleaning up a child who has used the toilet; after blowing one’s nose, coughing or sneezing; after touching an animal, animal feed or animal waste; and after touching garbage. (Centers for Disease Control and Prevention. Updated April 17, 2017)

To Jab or Not to Jab

The use of live and attenuated vaccines varies greatly from medication to medication and also dosage. The best thing to do before receiving any vaccinations while on immune-suppressing drugs is to talk to the doctor who prescribed the medication.

Other Considerations

Brushing teeth and flossing twice daily can prevent mouth infections that can cause serious problems for patients with autoimmune diseases.

Don’t ignore cuts and scratches. Clean and cover them, and monitor for symptoms of infection. Report a temperature over 100.5 degrees Fahrenheit, as well as any other symptoms of infection to a doctor immediately.

Avoid sick people, especially those with diarrhea or who are coughing or sneezing!

Practice very safe sex. Sexually transmitted diseases such as herpes can be a problem for anyone. But they can be very dangerous for people who are immunosuppressed. Condoms may not be enough. Even saliva can expose people to colds and viruses.

Food should be cooked, or if eaten raw, it should be thoroughly washed. And, different preparation areas should be utilized for raw meat, cooked meat and even raw vegetables such as salad. If separate areas aren’t possible, scrub the area thoroughly with a bleach solution between uses. Avoid raw fish and other seafood. Never eat rare ground beef as it has multiple surfaces mixed in with its surface bacteria. Properly cooked steaks that are seared on all surfaces may be eaten medium rare because surface germs are mostly eliminated.

Patients should stay out of crowded indoor areas. Those who want to go to the mall or movie theater should go when there will be the fewest people there. Weekday mornings are good for malls, and matinees are good for movies. Also, patients should try to sit near the front in a row with as few people as possible at the movies. And, in a mall, they should keep a 6-foot distance between them and anyone coughing or sneezing.

The common masks that most encounter are really designed to protect patients from sick people. But, they are most effective if worn by sick people. If someone is coughing or sneezing in an enclosed, crowded space, wearing a mask does everyone else a favor. Masks purchased at the pharmacy or grocery store are best at trapping large particles like mucus- or water-covered bacterium or viruses, which is what is usually expelled during a cough or a sneeze. Bacteria or viruses can spread via coughing or sneezing approximately 6 feet. Airborne viruses, on the other hand, can spread farther because these are not covered in mucus or water and so are smaller and lighter. Being at least 6 feet from a cough or sneeze generally provides safety. The point is that wearing a mask in public may protect against germs from a sneeze or cough that is close to one’s face, but unless patients plan on spending time with a friend who is coughing and sneezing, there rarely is a need for a mask.

If pet feces must be tended to, disposable gloves should be worn, and hands should be thoroughly washed afterward. Farm animals and petting zoos should be avoided.

Patients should ask their doctor before gardening. Soil contains many microbes that could pose a hazard. Always wash hands after touching soil.

Doctor Advice

The best strategy for autoimmune disease patients who are taking immune-suppressing medication is a discussion with their doctor about what is necessary for them concerning their level of medications, the environment they live in, their lifestyle and the need for any prophylactic medications.



Barbara Vujaklija, RN, is a former infection control supervisor and a former county health district infectious disease specialist in Ohio.

Reprinted with permission from the International Autoimmune Encephalitis Society at www.autoimmuneencephalitis.net

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Comments (2) -

Toni Bittner (Glendening)
7:29 AM on Friday, August 18, 2017

This is a great resource for my CVID "toolbox". I will be sharing this with family members and friends who sometimes need reminding that I have a PI and may not look sick. And since this article is framed in context of immunosupression from medication, I can share with even more people. I will check on IDF guidelines on live vaccine exposure window and some other recommendations for PI pts. Great resource!!

Richard W. Anderson
6:46 AM on Friday, September 08, 2017

I used to expect to get the flu and colds several times a year, and when I was diagnosed with myasthenia gravis five (5) years ago I thought things would only get worse.  HOWEVER, as a habit, I started taking just one (1) "Airborne" tablet (or the drugstore equivalent) dissolved in the water with which I wash-down my morning round of pills, and I have not had a cold or the flu in these past five (5) years.  Go figure!

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