Safe design and maintenance of bone marrow transplant units: a narrative review.

BACKGROUND:Patients undergoing bone marrow transplantation or chemotherapy for cancer are profoundly immunosuppressed. They are at risk for both endogenous and exogenous infections and require enhanced protection from infection while in hospital. OBJECTIVES:The aim of this narrative review was to determine the optimal design features of bone marrow transplant (BMT) units for reducing infection risk in these vulnerable patients. SOURCES:A literature search was performed on PubMed and other databases for documents published between January 2000 and October 2021. Keywords were: bone marrow transplant unit OR hematopoietic stem cell transplant unit OR haematology unit OR haemato-oncology unit AND design OR design guidelines OR design criteria OR ventilation specification OR HEPA filtration OR water outbreaks OR water system design. CONTENT:Guidelines and other papers pertaining to BMT unit design are discussed. Key design features identified from the literature to reduce infection risks include high efficiency particulate air filtration, positive-pressure ventilation, sufficient air changes and sealed rooms. The evidence for each of these parameters and other findings are discussed. We found no guidelines specific to water quality and control in BMT units. IMPLICATIONS:Guidelines on the various components of design were found, but no comprehensive guidance documents addressing all relevant aspects, such as ventilation, water, and other design features, were found. Literary publications and policy documents were combined and summarised to highlight key design features aimed at reducing infection risk in this vulnerable patient group. We propose the development of international guidance for the design of BMT units encompassing all components.