Preventative care will vary on the basis of transplant type, protocol, medications, and pretransplant viral studies.

INFECTION PROPHYLAXIS

Please see Chapter 15 on infectious diseases.

HOSPITAL INFECTION CONTROL

Hospital personnel should follow standard infection control and Center for Disease Control (CDC) guidelines to prevent nosocomial infections. The efficacy of different transplant-specific precautions in preventing nosocomial infections has not been studied. Hand washing continues to be the single most critical and effective procedure for preventing infection. If gloves are utilized, they should be changed between patients. All equipment should be sterilized or disinfected and Environment Protection Agency (EPA) registered.

Allogeneic hematopoietic stem cell transplantation (HSCT) patients should be placed in private rooms that have >12 air exchanges per hour and high-efficiency particulate air filters (HEPA) that are capable of removing particles ≥0.3 μm in diameter. It is generally considered good practice to treat all immuno-compromised people in HEPA-filtered rooms although the data are less clear than for allogeneic HSCT.

GUT DECONTAMINATION

Gut decontamination is used in some centers in all myeloablative and cord allogeneic procedures. Its use is most important when the risk of GVHD is higher (i. e., mismatched and URDs). In autologous and T-cell depleted patients an alternative is to use levofloxacin 500 mg PO starting on day 1 and continue through engraftment.