Admission to the BMT Unit

	Linda (BMT nurse) with patient

The BMT room

In the BMT Unit
Inside a BMT room

Patients stay in a special BMT room with a bed, TV, VCR, phone, sink, and private bathroom with a shower and bath. It is a special room which provides a positive pressure environment in which only highly purified (HEPA filtered) air is allowed to enter. The room is cleaned every day, and everyone who enters the room must follow specific isolation procedures where they receive a regimen of daily care that includes the administration of medications to minimize complications associated with the transplant process. Visitors to the BMT Unit must follow certain rules which protect the transplant recipient and help our program run smoothly.

All visitors (including doctors, nurses, other members of the health care team and family members) must wash their hands before entering and leaving the room. In addition, there is a clean anteroom (outer room) which separates the patient’s room from the hallway. The doors to the anteroom and patient room are kept closed at all times thus maintaining the positive pressure environment. This isolation policy is intended to minimize the risk of developing an infection during the transplant process. Transplant patients must stay in their room (except for radiation therapy or occasional tests or procedures that can only be done elsewhere) until the new marrow has begun to work. The total amount of time in the Transplant Unit varies; generally, it is 6-8 weeks.

Daily care

There are several routines that are done daily or several times a day to minimize those problems that may occur during the bone marrow transplant process.

Oral and intravenous medications

Antibiotics and medicines are given throughout the transplant period to reduce irritation of the stomach and intestines and prevent certain kinds of infections that frequently occur in a transplant recipient. These medications are continued until isolation is stopped, although some may be discontinued if your child is started on intravenous antibiotics because of fever or other signs of infection during the isolation period [while the neutrophil count (ANC) is less than 500]. The daily medications include:

Septra/Bactrim	An antibiotic for prevention of lung infection and infections originating in the intestines. It is given twice daily on Friday, Saturday and Sunday beginning 2 weeks post-transplant once the ANC is >500 for 3 consecutive days.
Fluconozole	An antibiotic which reduces the risk of some fungal infections..
Acyclovir	An anti-viral drug for prevention of herpes infections. When the patient is preparing to go home this medicine is switched from an IV to an oral preparation if prophylaxis is indicated.
Gammaglobulin	An intravenous medication which provides additional antibodies in the blood to help ward off infections. In the hospital the patient will receive a dose every 2 weeks. After discharge the patient will receive gammaglobulin every 4 weeks until his or her ability to fight infection returns to normal.
Sodium bicarbonate	An oral mouth wash that helps reduce the development of mouth sores and infection.
Sodium fluoride	An oral supplement to help maintain healthy teeth.

Rules for visiting the BMT unit

Immediate relatives are encouraged to spend time with the patient while he/she is hospitalized for a bone marrow transplant; however, there are a few rules that must be followed.

1. While the doctors are discussing the patients during morning rounds (8:30AM – 9:30AM), you are asked to either stay in the patient's room or not enter the BMTU. Therefore, if you want to be with the patient during those times you must be in the room before rounds begin and remain in the room until rounds are completed. This is done in order to preserve confidentiality.
2. Generally, only 2 visitors in the patient's room are permitted at any time.
3. All children must be screened before entering the BMTU. Parents must notify the nurse that the child needs to be screened. Children under 12 cannot visit inside the transplant room until the ANC is greater than 500 for three consecutive days.
4. Each room has its own private bath and toilet. Until the ANC is greater than 500 for three consecutive days only patients can use these facilities in order to minimize infection during this critical time. Showers are never to be used during the patient's stay in the hospital.
5. Until the ANC is greater than 500 for three consecutive days, visitors (including parents) cannot eat in the isolation rooms.