Infection prevention strategies in a stem cell transplant unit: impact of change of care in isolation practice and routine use of high dose intravenous immunoglobulins on infectious complications and transplant related mortality.
OBJECTIVE
Nursing in 'live islands' and routine high dose intravenous immunoglobulins after allogeneic hematopoietic stem cell transplantation were abandoned by many teams in view of limited evidence and high costs.


METHODS
This retrospective single-center study examines the impact of change from nursing in 'live islands' to care in single rooms (SR) and from high dose to targeted intravenous immunoglobulins (IVIG) on mortality and infection rate of adult patients receiving an allogeneic stem cell or bone marrow transplantation in two steps and three time cohorts (1993-1997, 1997-2000, 2000-2003).


RESULTS
Two hundred forty-eight allogeneic hematopoetic stem cell transplantations were performed in 227 patients. Patient characteristics were comparable in the three cohorts for gender, median age, underlying disease, and disease stage, prophylaxis for graft versus host disease (GvHD) and cytomegalovirus constellation. The incidence of infections (78.4%) and infection rates remained stable (rates/1000 days of neutropenia for sepsis 17.61, for pneumonia 6.76). Cumulative incidence of GvHD and transplant-related mortality did not change over time.


CONCLUSIONS
Change from nursing in 'live islands' to SR and reduction of high dose to targeted IVIG did not result in increased infection rates or mortality despite an increase in patient age. These results support the current practice.
Cantoni
Nathan
N
Division of Hematology, University Hospital Basel, Basel, Switzerland.
Weisser
Maja
M
Buser
Andreas
A
Arber
Caroline
C
Stern
Martin
M
Heim
Dominik
D
Halter
Jörg
J
Christen
Susanne
S
Tsakiris
Dimitrios A
DA
Droll
Armin
A
Frei
Reno
R
Widmer
Andreas F
AF
Flückiger
Ursula
U
Passweg
Jakob
J
Tichelli
André
A
Gratwohl
Alois
A
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000627:therapeutic use*; D017053:Infection Control / Q000379:methods*; D007239:Infections / Q000150:complications / Q000382:microbiology / Q000628:therapy / Q000821:virology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000451:nursing*; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000401:mortality / Q000451:nursing; D055815:Young Adult
D016756:Immunoglobulins, Intravenous