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Contribution of nurses to protective environment in haematopoietic cell transplant setting: an international survey by the European Society for Blood and Marrow Transplantation

Bone Marrow Transplantation volume 56, pages 1433–1440 (2021)Cite this article

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Abstract

Infections are frequently experienced complications for patients undergoing haematopoietic cell transplant (HCT). To assess current infection prevention strategies, an international survey among HCT nurses was conducted by the Nurses Group and IDWP of the EBMT. Nurse representatives from all EBMT transplant centres were invited to complete an online questionnaire on protective environment in adult and paediatric HCT units. A total of 141 complete questionnaires were returned for the isolation section and 26 for the paediatric section, the majority of respondents (89.4%) being nurses. A small number of centres (7.1%) reported not allowing visitors, the rest have rules for entering patient rooms. Most HCT units (99.3%) indicated that nurses play a critical role in infection prevention and measures differed between bacterial infections and viral infections. Many of the paediatric units (57.7%) had a play area, applying rules of entry. To our knowledge, this is the first survey on protective environment directed at nurses within HCT centres. Despite having different practices, most HCT units tend to decrease isolation procedures and the use of PPE for multi-drug resistant organisms. This must concur with an increase of hand hygiene compliance, for which our data show that there is still room for improvement.

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References

  1. Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, Storek J, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transpl. 2009;15:1143–38.

    Article  CAS  Google Scholar 

  2. Girmenia C, Bertania A, Picciocchi A, Perruccio K, Algarotti A, Busca A, et al. Incidence, risk factors and outcome of pre-engraftment gram-negative bacteremia after allogeneic and autologous hematopoietic stem cell transplantation: an Italian prospective multicenter survey. Clin Infect Dis. 2017;65:1884–96.

    Article  Google Scholar 

  3. Mikulska M, Raiola AM, Galaverna F, Balletto E, Borghesi ML, Varaldo R, et al. Pre-engraftment bloodstream infections after allogeneic hematopoietic cell transplantation: impact of T Cell-Replete transplantation from a haploidentical donor. Biol Blood Marrow Transpl. 2018;24:109–18.

    Article  Google Scholar 

  4. Centers for Disease Control and Prevention. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep.. 2002;51:1–48.

    Google Scholar 

  5. WHO. WHO guidelines on hand hygiene in health care. 2009. https://www.who.int/gpsc/5may/tools/who_guidelines-handhygiene_summary.pdf. Accessed 9 March 2020.

  6. Centers for Disease Control and Prevention, Infectious Disease Society of America & American Society of Blood and Marrow Transplant. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. MMWR Recomnm Rep.2000;49:1–125.

    Google Scholar 

  7. Schlesinger A, Mical P, Gafter-Gvili A, Rubinovitch B, Leibovici L. Infection-control interventions for cancer patients after chemotherapy: a systematic review and meta-analysis. Lancet Infect Dis. 2009;9:97–107.

    Article  Google Scholar 

  8. Yokoe D, Casper C, Dubberke E, Leee G, Muñoz P, Palmore T, et al. Infection prevention and control in health-care facilities in which heamatopoietic cell transplant recipients are treated. Bone Marrow Transpl. 2009;44:495–507.

    Article  CAS  Google Scholar 

  9. Rump B, Timen A, Verweij M, Hulscher M. Experiences of carriers of multidrug-resistant organisms: a systematic review. Clin Microbiol Infect. 2019;25:274–79.

    Article  CAS  Google Scholar 

  10. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81.

    Article  CAS  Google Scholar 

  11. CDC, 2019. https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html. Accessed 25 March 2020.

  12. Fenelon LE. Protective isolation: who needs it? J Hosp Infect. 1995;30:218–22.

    Article  Google Scholar 

  13. Biagioli V, Piredda M, Mauroni MR, Alvaro R, De, Marinis MG. The lived experience of patients in protective isolation during their hospital stay for allogeneic haematopoietic stem cell transplantation. Eur J Oncol Nurs. 2016;24:79–86.

    Article  Google Scholar 

  14. Biagioli V, Piredda M, Alvaro R, De Marinis MG. The experiences of protective isolation in patients undergoing bone marrow or hematopoietic stem cell transplantation: systematic review and metasynthesis. Eur J Cancer Care. 2017;26: https://doi.org/10.1111/ecc.12461.

  15. Munoz-Price LS, Banach DB, Bearman G, Gould JM, Leekha S, Morgan DJ, et al. Isolation precautions for visitors. Infect Control Hosp Epidemiol. 2015;36:747–58.

    Article  Google Scholar 

  16. Stoll P, Silla LM, Cola CM, Splitt BI, Moreira LB. Effectiveness of a Protective Environment implementation for cancer patients with chemotherapy-induced neutropaenia on fever and mortality incidence. Am J Infect Control. 2013;41:357–59.

    Article  Google Scholar 

  17. Styczynski J, Tridello G, Donnlly JP, Iacobelli S, Hoek J, Mikulska M, et al. Protective environment for hematopoietic cell transplant (HSCT) reecipients: The Infectious Diseases Working Party EBMT analysis of global recommendations on health-care facilities. Bone Marrow Transpl. 2018;53:1131–38.

    Article  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, McLaws ML, Moro ML, et al. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis. 2013;13:843–51.

    Article  Google Scholar 

  20. Anwar MM, Elareed HR. Improvement of hand hygiene compliance among health care workers in intensive care units. J Prev Med Hyg. 2019;60:E31–E35.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Oliveira AC, Gama CS, Paula AO. Multimodal strategy to improve the adherence to hand hygiene and self-assessment of the institution for the promotion and practice of hand hygiene. J Public Health. 2018;40:163–68.

    Article  CAS  Google Scholar 

  22. Bruchez SA, Duarte GC, Sadowski RA, da Silva Filho AC, Fahning WE, Belini Nishiyama SA, et al. Assessing the Hawthorne effect on hand hygiene compliance in an intensive care unit. Infect. Prev Pract. 2020:2. https://doi.org/10.1016/j.infpip.2020.100049.

  23. Maechler F, Schwab F, Hansen S, Fankhauser C, Harbarth S, Huttner B, et al. Contact isolation versus standard precautions to decrease acquisition of extended-spectrum ß-lactamase-producing Enterobacterales in non-critical wards: a cluster-randomised crossover trial. Lancet Infect Dis. 2020;20:575–84.

    Article  Google Scholar 

  24. Ford CD, Lopansri BK, Gazdik MA, Webb B, Snow GL, Hoda D, et al. Room contamination, patient colonization pressure, and the risk of vancomycin-resistant Enterococcus colonization on a unit dedicated to the treatment of hematologic malignancies and hematopoietic stem cell transplantation. Am J Infect Control. 2016;44:1110–15.

    Article  Google Scholar 

  25. Radanovich LJ Jr, Simberkoff MS, Bessesen MT, Brown AC, Cummings DAT, Gaydos CA, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. JAMA. 2019;322:824–33.

    Article  Google Scholar 

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Acknowledgements

We are extremely grateful to all nurses and other colleagues of EBMT centres who filled out the survey. Thanks for the time.

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Authors and Affiliations

  1. Bone Marrow Transplant Unit Denis Burkitt, St. James’s Hospital, Dublin, Ireland

    Iris Agreiter

  2. EBMT Data Office Leiden, Leiden, The Netherlands

    Anne E. Kozijn & Paul V. Bosman

  3. EBMT statistical unit, Leiden, The Netherlands

    Katerina Bakunina

  4. Hadassah Medical Center, Pediatric infectious diseases, Jerusalem, Israel

    Dina Averbuch

  5. Hematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom

    Jacqui Stringer & John Murray

  6. Division of Pediatric Hematology and Oncology, The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat Gan, Israel

    Daphna Hutt

  7. Division of Infectious Diseases, Department of Health Sciences, University of Genova, Ospedale Policlinico San Martino, Genova, Italy

    Malgorzata Mikulska

  8. Leiden University Medical Centre, Leiden, The Netherlands

    Theo Nering Bögel

  9. Pediatric BMT Unit, Bicocca University, Fondazione MBBM, Monza, Italy

    Marta Canesi

  10. Infection Prevention and Control, Great Ormond Street Hospital, London, UK

    Elaine Cloutman-Green

  11. Department of Hematology, Medical University, Poznan, Poland

    Lidia Gil

  12. IEO, European Institute of Oncology IRCCS, Milan, Italy

    Sarah J. Liptrott

  13. Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland

    Jan Styczynski

Authors
  1. Iris Agreiter
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  2. Anne E. Kozijn
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  10. Elaine Cloutman-Green
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  13. Sarah J. Liptrott
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  14. John Murray
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  15. Jan Styczynski
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Consortia

on behalf of Nurses Group and Infectious Diseases Working Party of EBMT

Contributions

IA, TNB, MC, ECG, JacS, DA, MM, LG, JS, SJL, PVB conceptualised and designed the study. AEK collected the survey responses and KB performed the data analysis. IA, JS, DA, DH, JacS interpreted the results. IA has been the primary person responsible for writing the manuscript. IA, JS, AEK, KB, DA, JacS, DH, MM, TNB, MC, ECG, PVB, LG, SJL, JM, were involved in drafting the work or revising it critically for important intellectual content. All authors approved the final version to be published and agree to be accountable for all aspects of the work.

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Correspondence to Iris Agreiter.

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Agreiter, I., Kozijn, A.E., Bakunina, K. et al. Contribution of nurses to protective environment in haematopoietic cell transplant setting: an international survey by the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 56, 1433–1440 (2021). https://doi.org/10.1038/s41409-020-01194-6

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