From the Guidelines
The CDC provides recommendations for protective precautions for hospitalized immunocompromised patients, including minimizing exposures to activities that might cause aerosolization of fungal spores and providing respiratory protection when they must leave their rooms. These recommendations are based on guidelines for environmental infection control in health-care facilities, which aim to protect vulnerable patients from healthcare-associated infections 1. The guidelines suggest that severely immunocompromised patients should be protected from activities that might cause aerosolization of fungal spores, such as vacuuming or disruption of ceiling tiles, and that they should wear a high-efficiency respiratory-protection device when leaving their rooms during periods of construction or renovation 1.
Some key precautions for immunocompromised patients include:
- Minimizing the length of time spent outside their rooms for diagnostic procedures and other activities 1
- Providing respiratory protection, such as an N95 respirator, when leaving their rooms 1
- Implementing protective environment measures, such as HEPA filtration of room air and positive room air pressure relative to corridors 1
- Practicing strict hand hygiene and wearing appropriate personal protective equipment 1
- Screening visitors for communicable diseases and restricting live plants and flowers from rooms due to potential fungal spores 1
These precautions are crucial in protecting immunocompromised patients from healthcare-associated infections, which can be severe or life-threatening due to their impaired immune responses 1. By following these guidelines, healthcare workers can help reduce the risk of infection and improve outcomes for these vulnerable patients.
From the Research
Protective Precautions for Immunocompromised Patients
The Centers for Disease Control and Prevention (CDC) provides guidelines for protective precautions to prevent infections in hospitalized patients who are immunocompromised.
- The decision to institute protective isolation is made as part of an individualized plan of care, taking into account the reason for, the nature, degree, and expected duration of immunosuppression of the affected person 2.
- Protective isolation denotes a range of practices used to protect immunocompromised hospital patients from infection, including the use of single rooms, hand hygiene, and proper handling of food, drink, and equipment 2.
- The CDC also provides guidance on the use of standard and isolation precautions in the hospital setting, including droplet, airborne, and contact precautions 3.
Recommendations for Specific Infections
- For infections such as Pneumocystis jirovecii pneumonia (PcP), high-dose cotrimoxazole is the most effective therapeutic option, and rapid initiation is essential to reduce mortality 4.
- Prophylactic trimethoprim/sulfamethoxazole (TMP/SMX) can prevent PcP and nocardiosis in immunocompromised patients, but alternative prophylaxis may be necessary in some cases 5.
- The diagnosis and treatment of PcP and other opportunistic infections require a critical evaluation of clinical symptoms, risk factors, radiologic features, and microbiological tests 4, 6.