Table 3.

Infection control guidelines with level AI, AII, and EII strength and quality of supporting evidence.

AI Recommendations
1. All persons should wash their hands before entering and after leaving the rooms of HSCT recipients and candidates undergoing conditioning therapy, or before any direct contact with patients regardless of whether they were soiled from the patient, environment or objects. 
2. All health care workers with diseases transmissible by air, droplet, and direct contact (e.g. varicella zoster virus, infectious gastroenteritis, herpes simplex lesions of lips or fingers and upper respiratory tract infections) should be restricted from patient contact and temporarily reassigned to other duties. 
3. When a case of laboratory confirmed legionellosis is identified in a person who was in the impatient HSCT center during all or part of the 2-10 days before illness onset, or if two or more cases of laboratory-confirmed Legionnaire's disease occur among patients who had visited an outpatient HSCT center, hospital personnel in consultation with the hospital infection control team should perform a thorough epidemiologic and environmental investigation or determine the likely environmental source(s) of Legionella species (e.g. showers, tap water faucets, cooling towers and hot water tanks. 
4. To control VRE exposure, strict adherence to standard infection control measures is necessary, as outlined in the text. 
5. All HCWs who anticipate contact with a Clostridium difficile-infected patient or the patient's environment or possessions should put on gloves before entering the patient's room and before handling the patient's secretions and excretions. 
6. HSCT candidates with a recently positive tuberculin skin test or a history of a positive skin test and no prior preventive therapy should be administered a chest radiograph and evaluated for active TB. 
AI Recommendations
1. All persons should wash their hands before entering and after leaving the rooms of HSCT recipients and candidates undergoing conditioning therapy, or before any direct contact with patients regardless of whether they were soiled from the patient, environment or objects. 
2. All health care workers with diseases transmissible by air, droplet, and direct contact (e.g. varicella zoster virus, infectious gastroenteritis, herpes simplex lesions of lips or fingers and upper respiratory tract infections) should be restricted from patient contact and temporarily reassigned to other duties. 
3. When a case of laboratory confirmed legionellosis is identified in a person who was in the impatient HSCT center during all or part of the 2-10 days before illness onset, or if two or more cases of laboratory-confirmed Legionnaire's disease occur among patients who had visited an outpatient HSCT center, hospital personnel in consultation with the hospital infection control team should perform a thorough epidemiologic and environmental investigation or determine the likely environmental source(s) of Legionella species (e.g. showers, tap water faucets, cooling towers and hot water tanks. 
4. To control VRE exposure, strict adherence to standard infection control measures is necessary, as outlined in the text. 
5. All HCWs who anticipate contact with a Clostridium difficile-infected patient or the patient's environment or possessions should put on gloves before entering the patient's room and before handling the patient's secretions and excretions. 
6. HSCT candidates with a recently positive tuberculin skin test or a history of a positive skin test and no prior preventive therapy should be administered a chest radiograph and evaluated for active TB. 
AII Recommendations
1. HCST centers should prevent birds from gaining access to hospital air-intake ducts. 
2. Appropriate gloves should be used by all persons when handling potentially contaminated biological materials. 
3. Work exclusion policies should be designed to encourage HCWs to report their illnesses or exposures. 
4. Visitors who might have communicable infectious diseases (e.g. upper respiratory tract infections, flu-like illnesses, recent exposure to communicable diseases, an active shingles rash whether covered or not, a VZV-like rash within 6 weeks of receiving a live attenuated varicella vaccine, or a history of receiving an oral polio vaccine within the previous 3-6 weeks) should not be allowed in the HSCT center or have direct contact with HSCT recipients or candidates undergoing conditioning therapy. 
5. If Legionella species are detected in the water supplying an HSCT center, the water supply should be decontaminated and eradication of Legionella should be verified. 
6. HSCT centers should follow basic infection control practices for control of MRSA infection and colonization, including hand washing between patients and use of barrier precautions, including wearing gloves whenever entering the MRSA-infected or MRSA-colonized patient's room. 
7. HSCT personnel should institute prudent use of all antibiotics, particularly vancomycin, to prevent the emergence of staphylococci with reduced susceptibility to vancomycin. 
8. Use of intravenous vancomycin is associated with the emergence of VRE; vancomycin and all other antibiotics, particularly antianaerobic agents, should be used judiciously. 
9. All patients with Clostridium difficile disease should be placed under contact precautions for the duration of the illness. 
10. When caring for an HCST recipient or candidate undergoing conditioning therapy with upper or lower respiratory tract infection, HCWs and visitors should change gloves and wash hands in circumstances outlined in the text. 
11. Visitors and HCWs with infectious conjunctivitis should be restricted from direct patient contact until the drainage resolves and the ophthalmology consultant concurs that the infection and inflammation have resolved to avoid possible transmission of adenovirus to HSCT recipients. 
12. For patients with suspected or proven pulmonary or laryngeal TB, HSCT personnel should follow guidelines regarding the control of TB in health care facilities. 
AII Recommendations
1. HCST centers should prevent birds from gaining access to hospital air-intake ducts. 
2. Appropriate gloves should be used by all persons when handling potentially contaminated biological materials. 
3. Work exclusion policies should be designed to encourage HCWs to report their illnesses or exposures. 
4. Visitors who might have communicable infectious diseases (e.g. upper respiratory tract infections, flu-like illnesses, recent exposure to communicable diseases, an active shingles rash whether covered or not, a VZV-like rash within 6 weeks of receiving a live attenuated varicella vaccine, or a history of receiving an oral polio vaccine within the previous 3-6 weeks) should not be allowed in the HSCT center or have direct contact with HSCT recipients or candidates undergoing conditioning therapy. 
5. If Legionella species are detected in the water supplying an HSCT center, the water supply should be decontaminated and eradication of Legionella should be verified. 
6. HSCT centers should follow basic infection control practices for control of MRSA infection and colonization, including hand washing between patients and use of barrier precautions, including wearing gloves whenever entering the MRSA-infected or MRSA-colonized patient's room. 
7. HSCT personnel should institute prudent use of all antibiotics, particularly vancomycin, to prevent the emergence of staphylococci with reduced susceptibility to vancomycin. 
8. Use of intravenous vancomycin is associated with the emergence of VRE; vancomycin and all other antibiotics, particularly antianaerobic agents, should be used judiciously. 
9. All patients with Clostridium difficile disease should be placed under contact precautions for the duration of the illness. 
10. When caring for an HCST recipient or candidate undergoing conditioning therapy with upper or lower respiratory tract infection, HCWs and visitors should change gloves and wash hands in circumstances outlined in the text. 
11. Visitors and HCWs with infectious conjunctivitis should be restricted from direct patient contact until the drainage resolves and the ophthalmology consultant concurs that the infection and inflammation have resolved to avoid possible transmission of adenovirus to HSCT recipients. 
12. For patients with suspected or proven pulmonary or laryngeal TB, HSCT personnel should follow guidelines regarding the control of TB in health care facilities. 
EII Recommendations
Abbreviations: HSCT, hematopoietic stem cell transplantation; TB, tuberculosis; VRE, vancomycin-resistant enterococci; HCWs, health care workers; VZV, varicella-zoster virus; MRSA, methicillin-resistant Staphylococcus aurea 
• Bacillus of Calmette and Guerin (BCG) vaccination is contraindicated among HSCT candidates and recipients because of its potential to cause disseminated or fatal disease among immunocompromised persons. 
EII Recommendations
Abbreviations: HSCT, hematopoietic stem cell transplantation; TB, tuberculosis; VRE, vancomycin-resistant enterococci; HCWs, health care workers; VZV, varicella-zoster virus; MRSA, methicillin-resistant Staphylococcus aurea 
• Bacillus of Calmette and Guerin (BCG) vaccination is contraindicated among HSCT candidates and recipients because of its potential to cause disseminated or fatal disease among immunocompromised persons. 
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