title: 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.
abstract: 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.
authors.affiliation: Division of Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: Nathan
authors.initials: N
authors.lastname: Cantoni
authors.forename: Maja
authors.initials: M
authors.lastname: Weisser
authors.forename: Andreas
authors.initials: A
authors.lastname: Buser
authors.forename: Caroline
authors.initials: C
authors.lastname: Arber
authors.forename: Martin
authors.initials: M
authors.lastname: Stern
authors.forename: Dominik
authors.initials: D
authors.lastname: Heim
authors.forename: Jörg
authors.initials: J
authors.lastname: Halter
authors.forename: Susanne
authors.initials: S
authors.lastname: Christen
authors.forename: Dimitrios A
authors.initials: DA
authors.lastname: Tsakiris
authors.forename: Armin
authors.initials: A
authors.lastname: Droll
authors.forename: Reno
authors.initials: R
authors.lastname: Frei
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Widmer
authors.forename: Ursula
authors.initials: U
authors.lastname: Flückiger
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.forename: André
authors.initials: A
authors.lastname: Tichelli
authors.forename: Alois
authors.initials: A
authors.lastname: Gratwohl
mesh_terms: 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
chemical_list: D016756:Immunoglobulins, Intravenous