Summary:
Aggressive infection control measures that include isolating patients within protective hospital environments have become a standard practice during allogeneic stem cell transplantation. A wide range of interventions includes the management of ventilation systems, BMT unit construction and cleaning, isolation and barrier precautions, interactions with health-care workers and visitors, skin and oral care, infection surveillance, and the prevention of specific nosocomial and seasonal infections. However, many of these practices have not been definitively proven to provide patients the intended benefit of decreased infection rates or improved survival. Furthermore, each intervention comes with a financial and social cost. With institutional cost containment efforts and recent trials suggesting that patients may be safely cared for in the outpatient environment after allogeneic transplantation, many widely held practices in managing the transplant environment are being reconsidered. With changing practices, transplant teams are encouraged to review local patterns of infections and associated complications and communicate regularly with infection control committees for guidance on the evolution of isolation needs for the immunosuppressed patient.
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References
Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Biol Blood Marrow Transplant 2000; 6: 659–713, 715, 717–727.
Hagen EA, Stern H, Porter D et al. High rate of invasive fungal infections following nonmyeloablative allogeneic transplantation. Clin Infect Dis 2003; 36: 9–15.
Busca A, Lovisone E, Aliberti S et al. Immune reconstitution and early infectious complications following nonmyeloablative hematopoietic stem cell transplantation. Hematology 2003; 8: 303–311.
Junghanss C, Marr KA, Carter RA et al. Incidence and outcome of bacterial and fungal infections following nonmyeloablative compared with myeloablative allogeneic hematopoietic stem cell transplantation: a matched control study. Biol Blood Marrow Transplant 2002; 8: 512–520.
Junghanss C, Boeckh M, Carter RA et al. Incidence and outcome of cytomegalovirus infections following nonmyeloablative compared with myeloablative allogeneic stem cell transplantation, a matched control study. Blood 2002; 99: 1978–1985.
McNeil MM, Nash SL, Hajjeh RA et al. Trends in mortality due to invasive mycotic diseases in the United States, 1980–1997. Clin Infect Dis 2001; 33: 641–647.
van Burik JH, Leisenring W, Myerson D et al. The effect of prophylactic fluconazole on the clinical spectrum of fungal diseases in bone marrow transplant recipients with special attention to hepatic candidiasis. An autopsy study of 355 patients. Medicine (Baltimore) 1998; 77: 246–254.
Marr KA, Seidel K, White TC, Bowden RA . Candidemia in allogeneic blood and marrow transplant recipients: evolution of risk factors after the adoption of prophylactic fluconazole. J Infect Dis 2000; 181: 309–316.
Fukuda T, Boeckh M, Carter RA et al. Risks and outcomes of invasive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning. Blood 2003; 102: 827–833.
McCann S, Byrne JL, Rovira M et al. Outbreaks of infectious diseases in stem cell transplant units: a silent cause of death for patients and transplant programmes. Bone Marrow Transplant 2004; 33: 519–529.
Sherertz RJ, Belani A, Kramer BS et al. Impact of air filtration on nosocomial Aspergillus infections. Unique risk of bone marrow transplant recipients. Am J Med 1987; 83: 709–718.
Anaissie EJ, Costa SF . Nosocomial aspergillosis is waterborne. Clin Infect Dis 2001; 33: 1546–1548.
Cornet M, Levy V, Fleury L et al. Efficacy of prevention by high-efficiency particulate air filtration or laminar airflow against Aspergillus airborne contamination during hospital renovation. Infect Control Hosp Epidemiol 1999; 20: 508–513.
Wald A, Leisenring W, van Burik JA, Bowden RA . Epidemiology of Aspergillus infections in a large cohort of patients undergoing bone marrow transplantation. J Infect Dis 1997; 175: 1459–1466.
Orth B, Frei R, Itin PH et al. Outbreak of invasive mycoses caused by Paecilomyces lilacinus from a contaminated skin lotion. Ann Intern Med 1996; 125: 799–806.
Lyytikainen O, Golovanova V, Kolho E et al. Outbreak caused by tobramycin-resistant Pseudomonas aeruginosa in a bone marrow transplantation unit. Scand J Infect Dis 2001; 33: 445–449.
Oren I, Zuckerman T, Avivi I et al. Nosocomial outbreak of Legionella pneumophila serogroup 3 pneumonia in a new bone marrow transplant unit: evaluation, treatment and control. Bone Marrow Transplant 2002; 30: 175–179.
Ljungman P . Respiratory virus infections in stem cell transplant patients: the European experience. Biol Blood Marrow Transplant 2001; 7 (Suppl.): 5S–7S.
Champlin RE, Whimbey E . Community respiratory virus infections in bone marrow transplant recipients: the MD Anderson Cancer Center experience. Biol Blood Marrow Transplant 2001; 7 (Suppl.): 8S–10S.
Nichols WG, Gooley T, Boeckh M . Community-acquired respiratory syncytial virus and parainfluenza virus infections after hematopoietic stem cell transplantation: the Fred Hutchinson Cancer Research Center experience. Biol Blood Marrow Transplant 2001; 7 (Suppl.): 11S–15S.
Harrington RD, Hooton TM, Hackman RC et al. An outbreak of respiratory syncytial virus in a bone marrow transplant center. J Infect Dis 1992; 165: 987–993.
Whimbey E, Champlin RE, Englund JA et al. Combination therapy with aerosolized ribavirin and intravenous immunoglobulin for respiratory syncytial virus disease in adult bone marrow transplant recipients. Bone Marrow Transplant 1995; 16: 393–399.
Taylor GS, Vipond IB, Caul EO . Molecular epidemiology of outbreak of respiratory syncytial virus within bone marrow transplantation unit. J Clin Microbiol 2001; 39: 801–803.
Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 1995; 44: 1–13.
Uttley AH, Collins CH, Naidoo J, George RC . Vancomycin-resistant enterococci. Lancet 1988; 1: 57–58.
Kirkpatrick BD, Harrington SM, Smith D et al. An outbreak of vancomycin-dependent Enterococcus faecium in a bone marrow transplant unit. Clin Infect Dis 1999; 29: 1268–1273.
Aker SN, Cheney CL . The use of sterile and low microbial diets in ultraisolation environments. J Parenter Enteral Nutr 1983; 7: 390–397.
Bodey GP, Freireich EJ, Frei III E . Studies of patients in a laminar air flow unit. Cancer 1969; 24: 972–980.
Bodey GP, Gehan EA, Freireich EJ, Frei III E . Protected environment-prophylactic antibiotic program in the chemotherapy of acute leukemia. Am J Med Sci 1971; 262: 138–151.
Dietrich M, Gaus W, Vossen J et al. Protective isolation and antimicrobial decontamination in patients with high susceptibility to infection. A prospective cooperative study of gnotobiotic care in acute leukemia patients. I: clinical results. Infection 1977; 5: 107–114.
Klastersky J, Debusscher L, Weerts D, Daneau D . Use of oral antibiotics in protected units environment: clinical effectiveness and role in the emergence of antibiotic-resistant strains. Pathol Biol (Paris) 1974; 22: 5–12.
Levine AS, Siegel SE, Schreiber AD et al. Protected environments and prophylactic antibiotics. A prospective controlled study of their utility in the therapy of acute leukemia. N Engl J Med 1973; 288: 477–483.
Ribas-Mundo M, Granena A, Rozman C . Evaluation of a protective environment in the management of granulocytopenic patients: a comparative study. Cancer 1981; 48: 419–424.
Schimpff SC, Greene WH, Young VM et al. Infection prevention in acute nonlymphocytic leukemia. Laminar air flow room reverse isolation with oral, nonabsorbable antibiotic prophylaxis. Ann Intern Med 1975; 82: 351–358.
Schwartz SA, Perry S . Patient protection in cancer chemotherapy. JAMA 1966; 197: 623–627.
Yates JW, Holland JF . A controlled study of isolation and endogenous microbial suppression in acute myelocytic leukemia patients. Cancer 1973; 32: 1490–1498.
Rodriguez V, Bodey GP, Freireich EJ et al. Randomized trial of protected environment – prophylactic antibiotics in 145 adults with acute leukemia. Medicine (Baltimore) 1978; 57: 253–266.
Buckner CD, Clift RA, Sanders JE et al. Protective environment for marrow transplant recipients: a prospective study. Ann Intern Med 1978; 89: 893–901.
Storb R, Prentice RL, Buckner CD et al. Graft-versus-host disease and survival in patients with aplastic anemia treated by marrow grafts from HLA-identical siblings. Beneficial effect of a protective environment. N Engl J Med 1983; 308: 302–307.
Beelen DW, Elmaagacli A, Muller KD et al. Influence of intestinal bacterial decontamination using metronidazole and ciprofloxacin or ciprofloxacin alone on the development of acute graft-versus-host disease after marrow transplantation in patients with hematologic malignancies: final results and long-term follow-up of an open-label prospective randomized trial. Blood 1999; 93: 3267–3275.
Passweg JR, Rowlings PA, Atkinson KA et al. Influence of protective isolation on outcome of allogeneic bone marrow transplantation for leukemia. Bone Marrow Transplant 1998; 21: 1231–1238.
Boyce JM, Pittet D . Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep 2002; 51: 1–45, quiz CE41–CE44.
Pittet D, Simon A, Hugonnet S et al. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med 2004; 141: 1–8.
Smith GC, Pell JP . Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ 2003; 327: 1459–1461.
Guideline for prevention of nosocomial pneumonia. Centers for disease control and prevention. Respir Care 1994; 39: 1191–1236.
Garner JS . Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996; 17: 53–80.
Larson EL . APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995; 23: 251–269.
Giles FJ, Rodriguez R, Weisdorf D et al. A phase III, randomized, double-blind, placebo-controlled, study of iseganan for the reduction of stomatitis in patients receiving stomatotoxic chemotherapy. Leukemia Res 2004; 28: 559–565.
Spielberger R, Stiff P, Bensinger W et al. Palifermin for oral mucositis after intensive therapy for hematologic cancers. N Engl J Med 2004; 351: 2590–2598.
Blazer BR, Weisdorf DJ, DeFor TE et al. Palifermin (a RHUKGF molecule) is safe and well tolerated in patients with hematologic malignancies (HM) undergoing high-dose chemoradiotherapy (HD-CRT) followed by allogeneic hematopoietic stem cell transplantation (HSCT). Biol Blood Marrow Transplant 2005; 11 (Suppl. 1): 4.
Ketterer N, Zaman K, Luthi F et al. Conventional hospital room is as safe as sterile unit for high-dose chemotherapy and peripheral blood stem cells (PBSC) transplantation. Blood 2004; 104: 390b (abstract 5222).
Cantoni R, Passweg J, Weisser M et al. Abandoning care in laminar air flow (LAF) units and routine high dose intravenous immunoglobulines (IVIG) in allogeneic hematopoietic stem cell transplantation (HSCT) does not increase mortality and rate of infections. Blood 2004; 104: 351b (abstract 5072).
Agha ME, Yeager AM, Evans C et al. Outpatient high-dose chemotherapy and autologous hematopoietic stem cell transplantation for multiple myeloma is associated with a low infection safety profile. Blood 2004; 104: 351b (abstract 5070).
Halim TY, Lavoie JC, Barnett MJ et al. High risk AML outpatient management: a retrospective analysis of bacteremia incidence following chemotherapy. Blood 2004; 104: 252a (abstract 884).
Sasaki T, Akaho R, Sakamaki H et al. Mental disturbances during isolation in bone marrow transplant patients with leukemia. Bone Marrow Transplant 2000; 25: 315–318.
Cohen MZ, Ley C, Tarzian AJ . Isolation in blood and marrow transplantation. West J Nurs Res 2001; 23: 592–609.
Gaskill D, Henderson A, Fraser M . Exploring the everyday world of the patient in isolation. Oncol Nurs Forum 1997; 24: 695–700.
Mank A, van der Lelie H . Is there still an indication for nursing patients with prolonged neutropenia in protective isolation? An evidence-based nursing and medical study of 4 years experience for nursing patients with neutropenia without isolation. Eur J Oncol Nurs 2003; 7: 17–23.
Russell JA, Poon MC, Jones AR et al. Allogeneic bone-marrow transplantation without protective isolation in adults with malignant disease. Lancet 1992; 339: 38–40.
Russell JA, Chaudhry A, Booth K et al. Early outcomes after allogeneic stem cell transplantation for leukemia and myelodysplasia without protective isolation: a 10-year experience. Biol Blood Marrow Transplant 2000; 6: 109–114.
Svahn BM, Remberger M, Myrback KE et al. Home care during the pancytopenic phase after allogeneic hematopoietic stem cell transplantation is advantageous compared with hospital care. Blood 2002; 100: 4317–4324.
van Tiel FH, Harbers MM, Kessels AG, Schouten HC . Home care vs hospital care of patients with hematological malignancies and chemotherapy-induced cytopenia. Ann Oncol 2005; 16: 195–205.
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Hayes-Lattin, B., Leis, J. & Maziarz, R. Isolation in the allogeneic transplant environment: how protective is it?. Bone Marrow Transplant 36, 373–381 (2005). https://doi.org/10.1038/sj.bmt.1705040
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DOI: https://doi.org/10.1038/sj.bmt.1705040
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