Airborne Fungal Spore Monitoring in a Protective Environment During Hospital Construction, and Correlation with an Outbreak of Invasive Aspergillosis

Iwen, Peter C.; Davis, Jack; Reed, Elizabeth; Winfield, Barbara A.; Hinrichs, Steven H.

doi:10.1086/646916

Cited by 49 publications

(24 citation statements)

References 13 publications

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“…In particular, their aerosolisation may be associated with demolition or renovation/construction work. 42,43 They can also originate inside the hospital but this requires prolonged damp conditions in the patient's proximity or renovation/construction work. 44 In addition to the prevention of infection by direct and indirect contact, it has to be ensured that all the air available for these patients to breath has had the fungal spores filtered from it.…”

Section: Protective Isolationmentioning

confidence: 99%

Hospital and community acquired infection and the built environment – design and testing of infection control rooms

Walker¹,

Hoffman²,

Bennett³

et al. 2007

Journal of Hospital Infection

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Negative-pressure isolation rooms are required to house patients infected with agents transmissible by the aerosol route in order to minimise exposure of healthcare workers and other patients. Housing patients in a separate room provides a barrier which minimises any physical contact with other patients. An isolation room held at negative pressure to reduce aerosol escape and a high air-change rate to allow rapid removal of aerosols can eliminate transmission of infectious aerosols to those outside the room. However, badly designed and/or incorrectly operating isolation rooms have been shown to place healthcare workers and other patients at risk from airborne diseases such as tuberculosis. Few standards are available for the design of isolation rooms and no pressure differential or air-change rates are specified. Techniques such as aerosol particle tracer sampling and computational fluid dynamics can be applied to study the performance of negative-pressure rooms and to assess how design variables can affect their performance. This should allow cost-effective designs for isolation rooms to be developed. Healthcare staff should be trained to understand how these rooms operate and there should be systems in place to ensure they are functioning correctly.

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Section: Protective Isolationmentioning

confidence: 99%

Hospital and community acquired infection and the built environment – design and testing of infection control rooms

Walker¹,

Hoffman²,

Bennett³

et al. 2007

Journal of Hospital Infection

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“…2 In the hospital setting, spore counts are generally lower (< 0.2/mm 3 ), but bursts of higher spore densities may occur during construction, disruption of the ventilation systems, carpet cleaning, and agitation of foam or dry-wall ceiling tiles, leading to nosocomial outbreaks. 124 Moreover, Aspergillus spores adhere to and remain viable on many surfaces, such as cotton bedding, clothing, carpeting, and ceiling tiles. 125,126 The circumstantial link between environmental spore counts and invasive aspergillosis has lead many institutions to construct high-efficiency particulate air filtration rooms on floors with BMT recipients and patients with leukemia to minimize nosocomial spore exposure.…”

Section: Nosocomial Infectionmentioning

confidence: 99%

Invasive Aspergillosis in Patients with Hematologic Malignancies

2003

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Invasive aspergillosis is an increasingly common and often fatal opportunistic fungal infection in patients with hematologic malignancies. Prolonged and profound neutropenia remains a key risk factor for the development of invasive aspergillosis. However, qualitative deficiencies in host immune responses resulting from prolonged corticosteroid therapy, graft-versus-host disease, and cytomegalovirus infection are important risk factors for the recurrence and progression of Aspergillus infections after bone marrow recovery. Early diagnosis of invasive aspergillosis remains a challenge, and few tools are available for monitoring its course once the diagnosis is established. Even with the recent introduction of new antifungal therapies, mortality in patients with invasive aspergillosis remains high, and uniformly effective prophylaxis or preemptive therapeutic strategies are lacking. Strategies such as combination antifungal therapy and immunotherapy often are used as first-line treatment approaches in patients with documented invasive aspergillosis despite a paucity of clinical trial data. Recent advances in our understanding of the epidemiology, pathogenesis, and treatment of invasive aspergillosis in patients with hematologic malignancies are reviewed. The problems and controversies associated with defining optimal treatment strategies for invasive aspergillosis in this heavily immunocompromised population are highlighted.

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“…Hospital outbreaks of pulmonary aspergillosis have occurred mainly among patients with granulocytopenia, especially in bone-marrow transplant units. 56 Although invasive aspergillosis has been reported in recipients of solid-organ (eg, heart) transplants, 57 the incidence of Aspergillus infections among these patients has been lower than among recipients of bone-marrow transplants, probably because granulocytopenia is less severe in solid-organ transplant recipients and the use of corticosteroids has decreased with the introduction of cyclosporine. 58 Inherent in the infection process initiated by the inhalation of infectious droplet nuclei is the area of deposition within the respiratory tract.…”

Section: Bioaerosol Infectivity and Virulencementioning

confidence: 99%

Characterization of infectious aerosols in health care facilities: An aid to effective engineering controls and preventive strategies

Cole

Cook

1998

American Journal of Infection Control

278

272

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Assessment of strategies for engineering controls for the prevention of airborne infectious disease transmission to patients and to health care and related workers requires consideration of the factors relevant to aerosol characterization. These factors include aerosol generation, particle size and concentrations, organism viability, infectivity and virulence, airflow and climate, and environmental sampling and analysis. The major focus on attention to engineering controls comes from recent increases in tuberculosis, particularly the multidrug-resistant varieties in the general hospital population, the severely immunocompromised, and those in at-risk and confined environments such as prisons, long-term care facilities, and shelters for the homeless. Many workers are in close contact with persons who have active, undiagnosed, or insufficiently treated tuberculosis. Additionally, patients and health care workers may be exposed to a variety of pathogenic human viruses, opportunistic fungi, and bacteria. This report therefore focuses on the nature of infectious aerosol transmission in an attempt to determine which factors can be systematically addressed to result in proven, applied engineering approaches to the control of infectious aerosols in hospital and health care facility environments. The infectious aerosols of consideration are those that are generated as particles of respirable size by both human and environmental sources and that have the capability of remaining viable and airborne for extended periods in the indoor environment. This definition precludes skin and mucous membrane exposures occurring from splashes (rather than true aerosols) of blood or body fluids containing infectious disease agents. There are no epidemiologic or laboratory studies documenting the transmission of bloodborne virus by way of aerosols.

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Airborne Fungal Spore Monitoring in a Protective Environment During Hospital Construction, and Correlation with an Outbreak of Invasive Aspergillosis

Abstract: The GASP method, although able to demonstrate that infection control measures reduced mold contamination of the air, was insensitive to detect levels of mold contaminates in time to prevent IA.

Cited by 49 publications

References 13 publications

Hospital and community acquired infection and the built environment – design and testing of infection control rooms

Hospital and community acquired infection and the built environment – design and testing of infection control rooms

Invasive Aspergillosis in Patients with Hematologic Malignancies

Characterization of infectious aerosols in health care facilities: An aid to effective engineering controls and preventive strategies

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