Minimizing Risk of Infection

Important Information for Parents

Can my child bring his or her favorite toy to the hospital?

Children may bring their favorite toys to the hospital. The hospital staff will work with you to help reduce the risk of infection. The toys will be kept in a closed storage container while not being used. Also, all toys must be wiped with antibacterial cloths before being taken into the child's room. Stuffed animals are usually not permitted; however, we recognize that children sometimes have a strong attachment to a particular stuffed animal or blanket. Exceptions will be made for such security objects as long as they are washed at least every other day.

Can my child have visitors while in the hospital?

Visits from friends and family can help alleviate some of the isolation felt by many patients during the BMT process. A few policies help keep the balance between the good that visitors can do for a patient's emotional well-being and the potential risk associated with such visits:

• Normal visiting hours are 10 a.m. to 8 p.m., daily. Parents are encouraged to visit at any time.
• Visitors should be limited to immediate family and selected close friends.
• There should be no more than three visitors in the patient's room at a time, including parents.
• Infants under the age of six months should not enter the patient's room. Infants older than six months may visit as long as they are immunized and in good health. Other siblings under the age of 17 will be permitted to visit as long as they are not sick.
• Anyone who has received live virus vaccines, such as oral polio, is not permitted to visit within 30 days of receiving the vaccine. If someone has recently been immunized, please ask the hospital staff if he/she can visit your child.
• No visitors with fever, upper respiratory infection, rash or other symptoms of contagious disease are permitted in your child's room.
• Everyone MUST wash their hands thoroughly before entering the room.
• Visitors wearing wool clothing must wear a gown.
• Down-filled blankets and pillows are not permitted.
• If there is any question as to the health of a visitor, it is best that he or she does not visit until symptoms have improved.

What can my child eat while in the hospital?

Your child may not feel like eating for awhile after the conditioning therapy and stem cell infusion. In order to maintain his/her weight, nutrition may be given into the vein through your child's central venous catheter. This source of nutrition is called Total Parenteral Nutrition (TPN).

To reduce the risk of infection, certain food restrictions apply while your child's immune system is suppressed.

• While hospitalized for transplant, patients are to use sterile ice and sterile or bottled water until the ANC is greater than 1000. The sterile ice is kept in the pantry room on the patient floor. Sterile water is available from the hospital.
• Packages of dried foods (crackers, cookies, etc.) are permissible and can be used multiple times once opened.
• Moist or wet foods can only be used once. Food and drink (including the sterile water) may not sit in the room and must be thrown away after being open for two hours.
• Fast food is also not allowed until the ANC>1000.
• Cooked food from home is allowed. There is a microwave oven available on the patient floor and a refrigerator for short-term storage of food.
• All cooked or canned fruit and vegetables are permitted. Only fresh fruit or vegetables that can be easily peeled or washed are permitted. For example: NO lettuce or berries until the ANC>1000 and until mouth sores have healed. Bananas, peeled apples and peeled cucumbers are okay.
• Parents and other visitors are not permitted to eat or drink in the room at any time during hospitalization for the transplant.

These restrictions are typically in place for a minimum of 100 days after the transplant.

Maintaining a Safe Environment

Your child's room must be kept as clean as possible to reduce the possibility of infection. Here are some important rules to follow to maintain a safe environment:

• All objects from outside the room must be wiped with antibacterial cloths.
• Frequent handwashing is essential to prevent the spread of infection. All visitors, including parents, should wash their hands each time prior to entering the room. Hands should be washed in the anteroom with the provided antibacterial soap and warm water.
• Fresh flowers or arrangements are not permitted in the room. Dried flowers and potpourri are not permitted.
• Balloons are not permitted in the room.
• Pets, although an important part of the family, are not permitted in the room. If possible, you could give your child videotapes of your beloved pets to help them to deal with the separation.
• Parents and other visitors are not permitted to use the toilet or shower in the patient's room. Other facilities are available.

After Leaving the Hospital

• Your child should avoid crowds (busy malls, indoor museums) and people with suspected infection. Think of a crowd as more than eight people in an average-size room.
• Your child should wear a face mask when in crowds.
• Your child should avoid people recently vaccinated with live viruses, such as chicken pox or oral polio. Discuss with your child's transplant physician if another family member requires immunizations during this period.
• Your family should wash hands frequently, especially before handling food.
• Your child should not swim in public pools or lakes for at least a year after transplant.
• Your child should minimize exposure to animals, especially barnyard animals. Patients should not handle animal feces.
• Your child should avoid construction sites and home remodeling.
• At the start of fever or other signs of infection, promptly call your child's transplant service. Infections are most easily treated when caught early.
• Your child should avoid using well water. If you have any questions, please discuss the situation with the transplant physician.

These restrictions are typically in place for a minimum of 100 days after the transplant. However, you should verify with the transplant physician before discontinuing these and other precautions.

Preparing Your Home for Your Child's Arrival

Before your child returns home, you can take these steps to minimize infection:

• Find a temporary home for pets and plants.
• Shampoo carpets and wash floors.
• Clean drapes, blinds and upholstered furniture.
• Change air-conditioning and furnace filters and then run them for several cycles to clear them of bacteria, fungi and viruses.
• Keep windows and doors closed.
• Turn off humidifiers.