Reverse isolation for neutropenic patients

Srividyalakshmi Seshadri, MD,1 and Michael A. Baumann, MD1,2

1 Department of Medicine, Division of Hematology/Oncology, Boonshoft School of Medicine, Wright State University, Dayton, OH, and 2 Department of Veterans Affairs Hospital, Dayton, OH

Hospitalized patients with neutropenia are commonly placed in reverse isolation intended to protect them from acquiring serious infections. This step often causes confusion and anxiety for patients, families, and health care workers. We reviewed the evidence for efficacy of various types of reverse isolation in select patient groups. Reverse isolation in laminar air flow or high-efficiency particulate air (HEPA)-filtered rooms reduces the incidence of infection and may improve survival for patients receiving allogeneic bone marrow or stem cell grafts. Patients with acute leukemia, aplastic anemia, or other conditions characterized by similarly severe and prolonged neutropenia have also been shown to develop fewer infections when kept in laminar air flow or HEPA-filtered rooms during treatment; however, survival is probably not improved for these patients. Patients receiving chemotherapy for solid tumors or lymphoproliferative diseases who become neutropenic have not been shown to benefit from reverse isolation the way that it is practiced in most hospital settings. Therefore, the practice should be discouraged in the management of these patients.

Commun Oncol 2008;5:628–632   print e-mail full text 91 kb