The value of protective isolation in preventing nosocomial infections in high risk patients

Since infection is a major cause of death in the patient whose immune responses have been compromised (immunocompromised patient), considerable attention has been focused on developing methods for the prevention of infection. This has primarily been directed at suppressing or eliminating the host's endogenous microbial burden and in decreasing the acquisition of new organisms. The prevention techniques which have been employed vary in complexity from single-room isolation to elaborate systems utilizing air-filtration and decontamination. The most sophisticated of these regimens is the total protected environment (TPE) consisting of a high-efficiency-particulate-air (HEPA)-filtered laminar air flow room which is surface disinfected and in which the patient is fully decontaminated with oral nonabsorbable antibiotics, cutaneous antisepsis, orificial antibiotics and a semisterile diet. The cumulative data to data have shown that the TPE affords a significant (albeit incomplete) reduction in the incidence of serious infections in severely compromised patients. Such protection from infection permits the delivery of novel therapies which might have been precluded because of consequent hematologic or immunologic toxicity. Nonetheless, the TPE is also elaborate, cumbersome and expensive, and its utilization for patients with immunodeficiency syndromes, bone marrow failure states and cancer depends heavily on the success of available therapy (e.g., immunoreconstitution, transplantation, intensive chemotherapy) for the patient's underlying disorder. Critical evaluation of the TPE and alternative prevention strategies are imperative to assure the effective and appropriate utilization of limited hospital resources.