Why do patients undergoing allogeneic hematopoietic stem cell transplantation need to enter a sterile cabin? How can they maintain cleanliness and hygiene?

Author: Yan Xia, deputy chief nurse, Peking University People's Hospital

Reviewer: Ren Dajiang, deputy chief physician of the Seventh Medical Center of the General Hospital of the Chinese People's Liberation Army

As we all know, patients undergoing allogeneic hematopoietic stem cell transplantation generally need to enter a sterile cabin, which is called a laminar flow clean room in medical terminology. Patients receiving autologous hematopoietic stem cell transplantation generally do not need to enter a sterile cabin.

Laminar flow clean room is a "safe island" for allogeneic hematopoietic stem cell transplant patients. Because the white blood cell count of allogeneic hematopoietic stem cell transplant patients will drop to zero after pretreatment. White blood cells are the "guards" protecting the human body. When the body is infected, white blood cells will eliminate bacteria and viruses in the body. Without white blood cells, the function of eliminating bacteria and viruses is lost. Therefore, patients undergoing hematopoietic stem cell transplantation must enter the "safe island" to ensure that there is no or less infection problem during the white blood cell "zero" period.

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Normally, patients undergoing allogeneic hematopoietic stem cell transplantation need to stay in the laminar flow clean room for about a month until the white blood cell count increases to 1000/mm³ before they can leave the laminar flow clean room and move to the general ward for further observation. In particular, patients who undergo allogeneic transplantation and whose matching is not completely matched need to be transferred to the general ward for further observation.

Before allogeneic hematopoietic stem cell transplant patients enter the laminar flow clean room, they must first be matched. Then the transplantation doctor will perform various examinations according to the situation. After all the examinations are completed and they are ready to enter the laminar flow clean room, they will be given health guidance.

First, you need to shave your hair because you need to do pretreatment, which is a very high-dose chemotherapy. It takes about ten days. During the pretreatment period, most of your hair will fall out. If you don't shave your hair, it will be difficult to clean. Second, you need to take a shower before entering the laminar flow clean room.

After entering the laminar clean ward, patients need to receive routine medicated bath treatment, that is, add disinfectant to the water and soak in the bathtub for about 20 minutes. In view of the fact that some patients cannot tolerate long-term immersion, which may cause fainting, it has now been changed to a shower method, using a bath containing chlorhexidine acetate for cleaning. This is to thoroughly clean the patient's skin, mouth, nose and perianal area. Because the skin will continue to secrete substances for 24 hours, a single medicated bath cannot completely solve the problem, so daily full-body sponge bath is crucial. When sponging, cool boiled water should be mixed with hot water to make warm water, and chlorhexidine acetate bath should be used to wipe the whole body. At the same time, the mouth, nose, eyes and perianal area also need to be cleaned daily.

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The nasal cavity is cleaned twice a day with iodoform ointment or iodophor, and then chloramphenicol eye drops are used to drip into the nose; the oral cavity is cleaned with mouthwash. There are two types of mouthwashes. One is sodium bicarbonate, which is mainly used to change the pH value of the oral cavity. The pH value of the oral cavity is acidic, and fungi are easy to grow in an acidic environment. Sodium bicarbonate mouthwash can prevent fungal infection. Another type is a mouthwash containing chlorhexidine acetate, which can prevent bacterial infection. There are two ways to rinse the mouth: gargle and gargle. Gargle means to hold it in the mouth as long as possible to allow the mouthwash to fully blend in the mouth. Gargle means to allow the cheeks to fully contact the mouthwash; the eyes are cleaned with antibiotic eye drops, 2-3 times a day; after each bowel movement, you must use 0.005% iodine tincture dilution for a sitz bath. Use a special basin with iodine tincture dilution and sit in it to clean the anus. Women cannot sitz bath during menstruation, and just rinse after each bowel movement.