Premium
Environmental prevention of infection in stem cell transplant recipients: a survey of the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation
Author(s) -
Hicheri Y.,
Einsele H.,
Martino R.,
Cesaro S.,
Ljungman P.,
Cordonnier C.
Publication year - 2013
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12064
Subject(s) - medicine , hepa , pancytopenia , transplantation , neutropenia , hematopoietic stem cell transplantation , basiliximab , conditioning regimen , bone marrow , surgery , chemotherapy , kidney transplantation , filter (signal processing) , computer science , computer vision
Background The developments of peripheral blood stem cells in autologous hematopoietic stem cell transplantation (auto‐ HCT ), and of reduced‐intensity conditioning ( RIC ) regimens in allogeneic HCT (allo‐ HCT ), have considerably changed the transplant approach. Prolonged neutropenia combined with severe mucosal damage and organ dysfunction is no longer the rule in the early post‐ HCT pancytopenic phase. Although strict isolation during pancytopenia was followed by most HCT units in the past, this may not be the current practice. Methods In 2008, a questionnaire was sent out to the 463 European Group for Blood and Marrow Transplantation centers, enquiring about their current environmental protection procedures; 89 (20%) returned the questionnaire. Results Most centers housed auto‐ HCT recipients in high‐efficiency particulate air ( HEPA )‐filtered rooms without (52%) or with laminar air flow ( LAF ) (29%) after total body irradiation ( TBI ), whereas HEPA ‐filtered rooms were used in 53% of auto‐ HCT conditioned without TBI . During the initial pancytopenic phase after allo‐ HCT , patients were housed in HEPA / LAF rooms in 50% and 42% of the centers, if a high‐dose myeloablative conditioning regimen or a RIC regimen was used, respectively. Surprisingly, 8–24% of the centers reported that no isolation procedures were used in patients colonized or infected with highly transmissible pathogens (i.e., C lostridium difficile , respiratory viruses, and varicella zoster virus). Conclusion In conclusion, universal recommendations for infected or colonized patients may be poorly known or applied in many HCT units.