Despite the sense of hope that comes with receiving an organ transplant, a common misconception among patients is their quality of life will be poor due to the risks of chronic infection. For the nearly 50,000 patients who underwent transplants in 2023, their continued health hinges on the effectiveness of their post-procedural protocols and how successfully they follow their care plans. Advances in infection prevention continue to have a profound impact on the rate of successful surgeries, but there’s still room for needed improvements through better collaboration among the global healthcare community to bring more continuity to universal medicine.
Harshal Shah, MD, is a hospitalist with infectious disease training from the Mayo Clinic who previously resided in the large city of Pune, a sprawling locale in western India. Dr. Shah is well-versed in the existing healthcare discrepancies worldwide and understands the dangers related to infection control continuity. A board-certified physician with the American Board of Internal Medicine, Dr. Shah is especially concerned about the use of antibiotics, particularly in transplant patients. His efforts to integrate more consistent infection control measures into surgical practices have culminated in a vast amount of published research and recent international recognition for his influence on care quality and the formation of a global educational resource for medical students and clinicians—the Global Med Institute. In late 2024, Dr. Shah was awarded the Most Profound Physician of the Year (Internal Medicine) award as part of the International Quality Award program.
Q: How did you become interested in infection control?
Shah: I grew up in India, which is a country with a long history of infectious disease outbreaks. Later, during my residency at the Southern Illinois University School of Medicine, I became aware of a real need for the proper utilization of antibiotics in post-surgical patients. The guidelines in the United States are quite different than in India, so I became intrigued by the need to administer antibiotics carefully, especially in transplant patients.
Q: How has infection control evolved, and what advances impact transplant patients the most?
Shah: Initially, infection prevention relied on basic hygiene measures and empirical antibiotic use. In transplant surgery, infection control is pivotal to survival and graft success. Antimicrobial prophylaxis, rapid diagnostics, infection control bundles, strict adherence to sterile techniques, and enhanced environmental hygiene have set new safety benchmarks. During my training, I observed a significant gap in the development of new antibiotics for acute infections, especially when compared to the substantial focus on developing medications for cancer and other chronic illnesses. I intend to help our industry become better educated on how to properly utilize antibiotics, especially as I see more people waiting years for their transplants and become more concerned about the ethical aspects of this area of medicine.
My research articles on surgical-site infections (SSIs) and mucormycosis and Rhodococcus infections provide critical insights into risk factors and outcomes while demonstrating how targeted interventions, such as optimizing pre-operative conditions and improving post-operative care, can reduce SSIs and associated complications. This research has informed clinical guidelines for managing these rare, severe infections by highlighting the importance of early diagnosis and combination antifungal therapy. Having such data with the emergence of newer infections and developing resistance is crucial.
Q: How does interdisciplinary teamwork influence infection management outcomes for transplant patients?
Shah: Among the significant and unique challenges that transplant patients face are immunosuppression, surgical complications, and a high risk of opportunistic infections. Addressing these issues requires a collaborative, multidisciplinary approach where specialists from diverse fields bring their expertise together to provide comprehensive care. I regularly spearhead initiatives that enhance documentation of infection prevention practices, standardize progress notes, and integrate infection surveillance tools. These changes enhance team communication, optimize patient care, and contribute to improved outcomes. Involvement in committees for antibiotic stewardship and infection control also helps implement hospital-wide strategies to reduce catheter-related bloodstream infections (CRBSIs) and hospital-acquired infections (HAIs).
When care providers collaborate with microbiologists, we can help to further technologies such as polymerase chain reaction and next-generation sequencing that enable rapid identification of pathogens to facilitate timely, precise treatment. My leadership roles and research contributions have led to the creation of an infection prevention bundle initiative that has reduced readmissions and optimized the length of stay for transplant patients. Through this interdisciplinary work, we are driving better outcomes, enhancing diagnostic accuracy, and customizing treatment plans with the development of integrated care pathways and the efforts of surgeons, intensivists, and infectious disease teams working collaboratively to manage pre-operative and post-operative infections. Depending on the organs being transplanted, these regimens are tailored based on feedback from specialists such as nephrologists, pulmonologists, and hepatologists. We’ve also seen improved communication and coordination through interdisciplinary meetings and the standardization of documentation to align patient care goals. These protocols have reduced delays in necessary interventions, enhanced patient monitoring, and fostered a culture of accountability.
Q: What are examples of common misconceptions about infection risks among transplant recipients?
Shah: Several misconceptions persist, potentially leading to inadequate precautions or unnecessary fears. Addressing these apprehensions through education and evidence-based strategies is critical to improving outcomes and quality of life for transplant patients.
One common misconception is that infection is inevitable. My research on SSIs has shown that targeted interventions can lower the incidence of infections and improve survival outcomes. Another misconception is that immunosuppressive therapy always increases infection risks excessively. This is inaccurate because immunosuppressive regimens are carefully tailored to balance the risk of infection with preventing organ rejection. Collaborative care between infectious disease specialists and transplant teams helps minimize these risks. My studies on opportunistic infections, such as invasive mucormycosis, demonstrate that even high-risk patients can achieve favorable outcomes with the appropriate preventive measures.
Also, many believe that infections after transplant surgery are solely hospital-acquired. The reality is that while HAIs are a concern, community-acquired infections and the reactivation of latent infections also pose significant risks. Pre-transplant screening for latent infections and post-discharge education are examples of strategies that have been proven vital in mitigating these risks. Another dangerous myth is that infection control is solely the responsibility of the healthcare team. Effective infection prevention requires active participation from patients and caregivers.
Educating patients on hygiene, adherence to medications, and recognizing early signs of infection empowers them to take an active role in their care. More recently, the belief that vaccinations are unsafe for transplant recipients has become a concern. While live vaccines are generally avoided, non-live vaccines are essential for protecting transplant patients from preventable diseases such as influenza and pneumococcus. My involvement in health camps and travel clinics has underscored the importance of educating patients about vaccine safety and effectiveness.
Q: What are some strategies to help dispel these myths?
Shah: Conducting pre- and post-transplant counseling sessions educates patients and caregivers about the real risks and evidence-based preventive measures. My work in patient education, including talks with hospitalized patients and health camp initiatives, emphasizes the importance of simplifying medical information to increase adherence and reduce misconceptions. It’s imperative for healthcare providers to communicate personalized infection risks and strategies to each patient, addressing their specific concerns. This involves collaboration between transplant coordinators, infectious disease specialists, and pharmacists. Evidence-based publications, including my research on CRBSIs, SSIs, and opportunistic infections, serve as valuable resources for healthcare professionals and patients alike, helping to dispel misinformation.
AI and the future of infection control practices
Today, tools driven by artificial intelligence (AI) help identify infection risks and stratify patients based on their susceptibility, facilitating tailored interventions. Incorporating these tools into care pathways reinforces the credibility of evidence-based strategies, according to Shah. Along with AI, data analytics will continue to transform healthcare with a wide offering of innovative solutions to complex challenges, including infection prevention. As a physician with a diverse background in health informatics, infection control, and quality improvement, Shah plans to remain deeply invested in exploring how these technologies can improve outcomes and workflows. “My experiences have solidified my belief that technology should serve as a tool to empower healthcare providers rather than to complicate our work,” he said.
Joe Darrah
Joe Darrah is an award-winning freelance journalist based in the Philadelphia region who covers a variety of topics, including healthcare. Connect with Joe on LinkedIn.
