Humanizing medical structures: the issue of a low-bacterial environment in the Bone Marrow Transplant Unit

A low-bacterial single room is an isolated space-time environment. In this special unit, allogenic bone marrow transplantation treated patients receive intensive care. Environmental stressors can influence emotional stability and perceived autonomy. This study analysed the effect of isolation on the distress and psychophysical perception. The Experiential World Inventory (EWI) of Bonneau and El Meligi was distributed to 18 patients (10 M, 8 F, mean age 39 years) at the beginning and the end of isolation (from 32 to 63 days, mean 45). Patients received bone marrow transplant from related or unrelated donors, after reduced or standard conditioning regimens. The questionnaire investigates 12 distinct scales: sensorial perception, time perception, body image, self image, social behaviour, thought, dysphoria, impulsiveness, hyper and hypoesthesia, euphoria, anxiety. The Italian edition of the EWI reports the reference values of a control group of 100 normal subjects. At the beginning of isolation, significant differences were seen between patients and control group for the impulsiveness and euphoria scales; after isolation, significant variations of scores were obtained on perception of time, body image, social behaviour, euphoria and impulsiveness. Prolonged isolation in a germ-free single room may induce progressive impairment of sensorial perception and body image, acceleration of time perception with reduced coping abilities, negative evaluation of self and a tendency to decrease communication with others. A better understanding of the relationship between the person and clinical environment, careful monitoring of psychological stability and reduction of environmental stressors, may improve coping in these patients.