European Group for Blood and Marrow Transplantation
Dr. Simone Cesaro
IDWP - Data Office Leiden, Postzone S-05-P
LUMC
P.O. Box 9600
2300 RC Leiden
The Netherlands
E-mail: [email protected]
www.ebmt.org
July 2012
Board Members
President
Alejandro Madrigal
(London)
Subject: Protective Environment for Stem Cell Transplant Recipients
Secretary
Anna Sureda
(Barcelona)
Treasurer
Fred Falkenburg
(Leiden)
Dear Colleague,
Nurses Group President
Elisabeth Wallhult
(Gothenburg)
The Center for International Blood and Marrow Transplant Research (CIBMTR)
EBMT 2013 Congress
President
Jane Apperley
(London)
Hematopoietic Cell Transplantation Recipients: A Global Perspective which involved
Working Party
Chairpersons
coordinated the Guidelines for Preventing Infectious Complications among
the National Marrow Donor Program (NMDP), the American Society for Blood and
Marrow Transplant (ASBMT), the Canadian Blood and Marrow Transplant Group
(CBMTG), the Infectious Diseases Society of America (IDSA), the Society for
Acute Leukaemia
Mohamad Mohty
(Paris)
Healthcare Epidemiology of America (SHEA), the Association of Medical Microbiology
Aplastic Anaemia
Judith Marsh
(London)
(CDC) and, last but not least, the European group for Blood and Marrow
and Infectious Diseases (AMMI), the Center for Disease Control and Prevention
Transplantation (EBMT) (2009).
Autoimmune Diseases
Dominique Farge-Bancel
(Paris)
Chronic Malignancies
Nicolaus Kröger
(Hamburg)
In these guidelines there were clear recommendations with respect to hospital room
Immunobiology
Andrea Velardi
(Perugia)
be placed in Protective Environment rooms that incorporate several features including
Inborn Errors
Bobby Gaspar
(London)
design and ventilation (Yokoe et al, 2009). Specifically, HCT recipients should ideally
central or point-of-use HEPA filters with 99.97% efficiency for removing particles ≤0.3
µm in diameter (See summary table). At the same time the literature supporting these
Infectious Diseases
Simone Cesaro
(Verona)
recommendations could only be graded as level 3 as there were no well-executed
Transplant-related
Complications and
Quality of Life after SCT
Rafael Duarte
(Barcelona)
cohort or case-controlled analytical studies, multiple time-series studies or dramatic
Lymphoma
Peter Dreger
(Heidelberg)
studies, and reports of expert committees.
Paediatric Diseases
Christina Peters
(Vienna)
Solid Tumours
Marco Bregni
(Milan)
trials –whether or not randomized and controlled- and very little evidence to hand from
results from uncontrolled experiments. Hence reliance had to be placed on the
opinions of respected authorities which are based on clinical experience, descriptive
Since the issue is of practical importance the Infectious Diseases Working Party of the
EBMT would like to ask you to answer the following questions to gain an idea of what
__________________________________________________________________________________________________________
EBMT Registered Office: P.O. Box 3151, 6202 ND Maastricht, The Netherlands
Registration Number: 41166105 · VAT Number: NL8042.17.257.B01
is done in Europe to attain the norms proposed. Please be reassured that the
information obtained will be handled to guarantee the anonymity of your centre. We
only want to gain an impression of what is done on average and also to see to what
extent the recommendations made are feasible and to try to establish a norm for the
EBMT.
Summary of the recommendations
≥12 air exchanges/hour
AIII
Central or point-of-use HEPA filters with 99.97%efficiency for
AIII
removing particles ≤0.3 µm in diameter
Filters should be replaced regularly based on manufacturers’
AIII
recommendations, and, when there is ongoing construction,
filtration efficiency should be monitored frequently to best determine
appropriate time for replacement
Directed airflow so that air intake occurs at 1 side of the room and
BIII
air exhaust occurs at the opposite side
Consistent positive air pressure differential between the patient’s
BIII
room and the hallway ≥2.5 Pa (i.e., 0.01 inches by water gauge)
Well-sealed rooms (e.g., filling the gaps between walls and
BIII
windows, outlets, floor, and ceiling) should always be used for HCT
patients to prevent infiltration of air from outside the room that could
allow entry of spores and hinder maintenance of proper pressure
differential
Continuous pressure monitoring, especially while rooms are
BIII
occupied
Self-closing doors to maintain constant pressure differentials
BIII
Consideration should be given to using monitoring systems that will
CIII
set off an alarm when the pressure differential between any
Protective Environment room and adjacent hallway or anteroom
falls to less than 2.5 Pa, to alert staff to possible engineering
failures
To enable the nursing staff to observe the HCT recipient even when
CIII
the doors are closed, windows can be installed in either the door or
the wall of the HCT recipient’s room
__________________________________________________________________________________________________________
EBMT Registered Office: P.O. Box 3151, 6202 ND Maastricht, The Netherlands
Registration Number: 41166105 · VAT Number: NL8042.17.257.B01
Should you want to participate, we kindly ask you to complete the Survey before
September 1st, 2012.
We would like to thank you in advance for your cooperation in this important study
and are looking forward to your participation.
Sincerely,
Jennifer Hoek
Peter Donnelly
Investigator of the study
Simone Cesaro
IDWP Chair
Data office Infectious Diseases Working Party (EBMT)
Department of Medical Statistics & Bioinformatica
Postzone S-05-P
LUMC
PO Box 9600
2300 RC Leiden
The Netherlands
Telephone: +31 71 526 5668
Faxnr: +49 180 500 290 623 (fax to e-mail system)
Faxnr:+49 711 4900 8723 (fax to e-mail system)
e-mail: [email protected] or [email protected]
__________________________________________________________________________________________________________
EBMT Registered Office: P.O. Box 3151, 6202 ND Maastricht, The Netherlands
Registration Number: 41166105 · VAT Number: NL8042.17.257.B01