A national survey of infection prevention practices on bone marrow transplant units

To identify and describe bone marrow transplant (BMT)-specific infection prevention measures in the United States.

Survey design using a mailed questionnaire.

BMT programs across the United States.

91 BMT programs (80.5% response rate).

A questionnaire containing both closed- and open-ended items was mailed to identified nurse contacts following introductory phone calls. Descriptive statistics were computed on responses to closed-ended questions; content analysis was performed on responses to open-ended questions.

Although all programs used some type of protected environment, practices varied considerably. Wide variation existed in cover-garment and hand-washing practices, regardless of the type of protected environment in use. Other protective measures included skin decontamination (69%), gut decontamination with oral nonabsorbable antibiotics (30%), antifungal therapy (73%), acyclovir therapy (82%), immunotherapy (73%), granulocyte-macrophage colony stimulating factor therapy (58%), and modified microbial diets (66%). Numerous mouth care regimens, visitor and patient precautions, and environmental maintenance routines were described.

Little standardization of infection-prevention practices exists nationwide.

Efforts should be made to test the cost effectiveness and benefits of the various measures in use prior to the development of national standards.