As we wait for your child’s transplanted stem cells to grow, or engraft, their immune system is unable to fight against any sources of infections.
On the day of your child’s blood and marrow transplant (BMT), they will be admitted into a room which will protect her from becoming infected by germs such as bacteria, viruses or fungus. This room is called a protective isolation room. It is particularly important that your child is safe from any potential sources of infection that may be carried by visitors or in the environment.
The protective isolation room may contain special air flow that filters the air in the room. This is called laminar air flow (LAF).
For autologous BMT, LAF rooms are not strictly needed and the BMT can be done in a standard patient room.
Your child will be placed in protective isolation from the day of their transplant until the transplant physician decides that it is appropriate for them to leave. Usually, your child is ready to leave protective isolation when the concentration of a specific type of white blood cell (neutrophils) reaches a safer level - about 500 million neutrophils cells per liter of blood (0.5 X 109/L). This is called the absolute neutrophils count (ANC).
When entering your child’s room, you need to wear a long-sleeved gown. You do not need to wear masks, although nurses may be wearing a mask when they are doing a sterile procedure. For example, the nurse will wear a mask when changing your child’s central venous line (CVL) dressing. You need to wear clean, non-sterile gloves when they have contact with blood or other body fluids.
Laundry
During your child’s transplant, they must change their clothes every day. When cleaning your child’s clothes at home, please remember to:
- wash your child's clothes separately from the rest of the family's laundry
- use the hot water cycle
- dry the clothes in the dryer
- wash your hands before you touch the newly washed clothes
- bring the clothes to the hospital in a clean, double bag
Hand washing
Hand washing is the best way to prevent infection from spreading. All hospital staff, parents and everyone else entering the protective isolation room must wash their hands in the scrub sink or use the alcohol based soaps in containers mounted on the walls. Scrub your hands for two full minutes in the morning, after meals and after bathroom breaks.
Personal items and supplies
Anything that you bring into your child’s protective isolation room must be clean. Any item you bring in that is shared between children must be wiped off with a surgical towel which has been soaked in an antiseptic solution called Dynakil. If an item falls on the floor, make sure to wash it again in Dynakil before bringing it back into the room. Wash toys brought from home with soap and water, then with Dynakil just before bringing it into your child’s room.
Illness and visiting children in protective isolation
To protect your child from infection, the visiting policy in the hospital is very strict. Any person who has any sign of illness will not be allowed to enter the BMT unit.
Do not expose your child to anyone who might be ill. Symptoms can include:
- fever
- runny nose
- cough
- diarrhoea
- cold sore
- contact with chickenpox
Immediate family members, like brothers, sisters and grandparents may be permitted to visit your child before their transplant when they are undergoing chemotherapy or after your child leaves the isolation room.
While visiting your child in the LAF room, you must avoid:
- touching your hair or face with your hands
- sitting on your child's bed
- picking up items from the floor
- be cautious when hugging or kissing your child
- food is not allowed inside the room. Only your child can eat meals inside the room
It will be difficult to cope with these restrictions while your child is in protective isolation. But it is very important since at this time, your child is most likely to get an infection. Some infections are spread even before symptoms show up, and you may pass these on to your child.
Step-down Isolation
Once your child’s transplanted blood and marrow starts to grow, or engraft, the amount of white blood cells in his body will begin to increase. One type of white blood cell is called neutrophils. As we mentioned above, when the amount of neutrophils is above 500 million cells per liter of blood, your child does not need to follow the strict protective isolation restrictions.
When your child reaches this phase of the transplant, it is called step-down isolation. At this time, you still have to wash your hands before visiting your child. However, you do not need to wear a gown in your child’s room.
In step-down isolation, your child may move to a regular room if available. She can also take a walk in the halls of the unit. However, your child still has very little natural protection against infection and needs to wear a mask when outside the room. Do not expose your child to unnecessary risks of infection.
Your child’s physician and nurse will discuss what restrictions you and your child need to follow while in step down isolation.