Back to basics
Infections: risk and prevention
There are a number of ways that lymphoma and its treatment can increase your risk of developing an infection – lowered immunity, having an intravenous (IV) line in place between treatments and lack of nutrients.
Lowered immunity
Lymphoma affects your immune system. It stops lymphocytes from working properly (a type of white blood cell that helps fight infection). Your ability to fight infection is also lowered if you have:
- neutropenia, which can be caused by treatments (chemotherapy or immunotherapy) or by having lymphoma in the bone marrow. Your medical team might prescribe courses of growth factor injections to prevent this, especially after treatments
- had a stem cell transplant or cellular therapies
- had your spleen removed (splenectomy), as the spleen is part of your immune system
- other long-term conditions such as diabetes, or a condition that needs regular medication such as steroids.
Having an intravenous line (IV) in place between treatments
Having a peripherally inserted central catheter (PICC line) or tunnelled central line in place between treatments makes it easier to do regular blood tests and give you intravenous treatments. However, it can also give germs a way to get into your bloodstream, which can lead to infection.
To reduce the risk of infection, a member of your medical team regularly cleans (flushes) your line and changes the dressing. How often they do this depends on the type of line you have and on the policies at your hospital. If you notice any signs of infection around the line before your next check, contact a member of your medical team.
Lack of nutrients and dehydration
Good diet and nutrition and drinking enough fluids helps give your body nutrients to fight infections.
Coming into contact with germs that cause infection
Harmful germs (microbes such as bacteria, fungi, yeast or viruses) can cause infections and make you unwell. You might come into contact with these germs by:
- being near to someone who has an infection
- touching an infected surface
- eating or drinking contaminated food or water
- breathing in particles of air or water droplets that are infected.
Symptoms of infection
The exact symptoms infections cause are often limited to the parts of the body that are affected. For example, colds affect the airways and cause a runny nose. A stomach bug that affects the digestive tract (gastroenteritis) causes sickness and diarrhoea. Your medical team can advise you about any that you should be particularly aware of, including any that are not listed.
Common symptoms and signs of infection include, but are not limited to, any one or more of the following:
- temperature over 38°C/100.4°F (fever)
- temperature below 35°C/95°F (hypothermia)
- pain, redness, discharge, swelling or heat at the site of a wound or intravenous (IV) line such as a chemotherapy central line or PICC line
- chills and sweating
- shivering (even if you don’t have a fever, which can be more likely if you’re taking steroid medication)
- feeling generally unwell, confused or disoriented
- blocked nose, earache, sore throat or mouth
- cough, yellow or green phlegm or snot (mucus), difficulty breathing
- diarrhoea
- vomiting
- a feeling of burning or stinging when you wee, or needing to wee more often than usual
- vaginal discharge or itching
- headaches or unusual and new stiffness of the neck, with discomfort around bright lights
- new and increasing pain anywhere in the body.
Keep a thermometer so that you can easily check your temperature. Seek medical advice promptly if you have a raised temperature, especially if you have other symptoms of infection as well. Some of the symptoms could be caused by lymphoma or its treatment, but it is important to seek medical attention early. Some infections can cause more serious problems by getting into the bloodstream. This is known as sepsis and affects the whole body. It causes symptoms such as fever, tiredness, headaches, aches and pains.
What should I do if I think I might have an infection?
Contact your GP or a member of your medical team immediately if you have any possible symptoms or signs of infection, even if you think they might be minor. Don’t wait to see if they worsen. This is because infection can be serious for people who have lymphoma. The risk is further heightened if you have neutropenia. You might need urgent medical attention, so seek help as soon as you can.
If you’re advised to go to hospital, go immediately. Prompt medical attention means you can get tests and treatment such as antibiotics that you might need quickly. This can prevent any issues from becoming more serious.
Your medical team should give you telephone numbers to call at any time. This includes during the night and over weekends. If you haven’t been given this information, ask your consultant or clinical nurse specialist for it.
How can I lower the risk of infections?
While you can’t protect yourself completely from infection, you can help lower your risk by minimising contact with germs, keeping good personal hygiene and protecting your skin. You should also take medical advice about any vaccinations you might need or should not have.
Minimising contact with germs
Think about ways of minimising your contact with germs:
- Avoid places where infection can spread easily, such as cinemas, busy shops, public transport in rush-hour, hot tubs and public swimming pools.
- Keep your distance from family, friends and others with infections such as a cold, flu, diarrhoea, vomiting or chickenpox.
- Keep household surfaces clean, using a disinfectant before preparing food.
- Do not share cups, mugs or cutlery, or personal items such as towels or toothbrushes.
- Wear protective gloves when gardening, cleaning, and clearing up after pets – if possible, see if someone else can help with these tasks.
Keeping good personal hygiene
- Wash your hands well before preparing and eating food, after touching animals and after using the toilet.
- Have a warm bath or shower every day. If you have a PICC or central line in place, ask your medical team for advice on bathing and showering.
- Keep good dental hygiene. Use a soft toothbrush and an alcohol-free antibacterial mouthwash.
- Take an alcohol-based sanitiser or antibacterial wipes with you when you go out. Use these if there isn’t water and soap available to clean your hands when you need to.
Protecting your skin
Avoid giving germs a way into your body:
- Moisturise your skin with a lotion if your skin becomes dry or cracked.
- Take care to avoid cuts when using knives or scissors.
- If you shave, consider using an electric shaver instead of a razor.
- Wear shoes outdoors. Avoid walking barefoot, even indoors.
- Don’t squeeze spots or scratch scabs.
If you cut, scratch or graze yourself, wash your hands and clean the wound with tap water. Use a clean towel to pat the wound dry and place a sterile dressing on it. Avoid picking at scabs because this can increase the risk of germs spreading into the body.
Avoiding food poisoning
Food poisoning (foodborne illness) can happen if you eat or drink food that’s contaminated, for example with a virus or bacteria.
The World Health Organization (WHO) gives five key steps to food safety:
- Keep clean – wash your hands thoroughly and make sure that food preparation surfaces and utensils are clean.
- Separate – separate raw meat, raw poultry and raw seafood from other foods. Use separate utensils to prepare them. Wash your hands thoroughly before and after preparing these foods.
- Cook your food thoroughly – this is especially important when cooking meat, eggs and seafood. Make sure that foods like soups or stews are warmed to at least 70°C. Reheat cooked food thoroughly.
- Store foods at safe temperatures – generally, this means below 5°C for cold or perishable food and above 60°C for hot food. Once food is cooked, don’t leave it at room temperature for more than 2 hours; put it in the fridge.
- Use safe water and raw ingredients – wash fruit and vegetables before eating them, choose pasteurised (heat-treated) ingredients and do not eat or drink products that have passed their expiry date.
