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Bone Marrow Transplant. 2018 Sep;53(9):1131-1138. doi: 10.1038/s41409-018-0141-5. Epub 2018 Mar 13.

Protective environment for hematopoietic cell transplant (HSCT) recipients: The Infectious Diseases Working Party EBMT analysis of global recommendations on health-care facilities.

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Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland.
Department of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Policlinico G.B. Rossi, Verona, Italy.
Department of Haematology, Radboud UMC, Nijmegen, The Netherlands.
Department of Biology, University of Tor Vergata, Rome, Italy.
EBMT Data Office, Leiden, The Netherlands.
Division of Infectious Diseases, Department of Health Sciences, University of Genova, Ospedale Policlinico San Martino, Genova, Italy.
Oncology Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
Department of Hematology, Medical University, Poznan, Poland.


International guidelines on protective environment for HSCT recipients proposed a set of 10 global recommendations in 2009 on protective environment (GRPE) concerning hospital room design and ventilation. The EBMT Infectious Diseases Working Party undertook a survey on the status on protective environment for HSCT recipients with the aim of surveying current practices and their agreement with GRPE recommendations. The questionnaire consisted of 37 questions divided into 5 sections about filtration, air changes, maintenance, and the protective environment in rooms and the surrounding unit. Overall, 177 centres (response rate 33%) from 36 countries responded, indicating that 99.4% of patient rooms were equipped with HEPA filters, but only 48.6% of the centre's staff were aware of, and could confirm, regular replacement of filters based on manufacturers' recommendations. Well-sealed rooms were used in terms of windows (70.6%), ceilings (35%), and plumbing pipes (51.4%). The sensor monitors in the patient room used to determine when the HEPA filters require changing were installed only in 18.1% of centres. Only 1 centre fulfilled all 10 GRPE recommendations, while 62 centres fulfilled the 3 level "A" recommendations. In conclusion, HEPA-filtered rooms are available in almost all centres, while fewer centres fulfilled other requirements. Knowledge on the details and maintenance of protective environments in the HSCT setting was inadequate, reflecting a lack of communication between the health personnel involved, hospital infection control and the hospital maintenance services.


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