Control of Construction-Associated Nosocomial Aspergillosis in an Antiquated Hematology Unit

Loo, Vivian G.; Bertrand, Cléline; Dixon, Catherine; Vityé, Debbie; DeSalis, Beverley; McLean, A. Peter H.; Brox, Alan; Robson, Hugh G.

doi:10.1086/647317

Cited by 100 publications

(58 citation statements)

References 13 publications

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“…This dramatic increase in the incidence of IPA was clearly related to the beginning of extensive construction and renovation work undertaken in our older hospital building. Air samples were obtained for Aspergillus spore counts and disclosed much higher counts (15 spores/m 3 ) in the wards compared to 0.2-3 spores/m 3 in the literature [21,22]. Since at that time there were no hospital areas with a special ventilation system, it was decided to implement several preventive measures using chemoprophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…The median length of neutropenia was 18 days (range 5-33). Eighteen of 28 patients had AML with a median neutropenic length of 20 days (range 5-33), and 10/18 patients had ALL with a median neutropenic period of 13 days (range [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Section: Time Framesmentioning

confidence: 99%

“…Outbreaks of nosocomial invasive aspergillosis during the last two decades have been attributed to ongoing construction and were in correlation with increased air counts of Aspergillus organisms [20][21][22]. During hospital construction and indoor building renovation in our hospital, a nosocomial outbreak of IPA occurred among patients with acute leukemia (AL) housed in a regular ward that has only natural ventilation.…”

Section: Introductionmentioning

confidence: 95%

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Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters

et al. 2001

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during extensive hospital construction and indoor renovation, a nosocomial outbreak of invasive pulmonary aspergillosis occurred in acute leukemia patients treated in a regular ward that has only natural ventilation. The observed infection rate was 50%. Chemoprophylaxis with intravenous continuous low-dose amphotericin B was then instituted as a preventive measure. During the next 18 months invasive pulmonary aspergillosis developed in 43% of acute leukemia patients. After that period a new hematology ward was opened with an air filtration system through high-efficiency particulate air filtration (HEPA) filters, and a bone marrow transplantation program was started on the hematology service. During the following three years, none of the acute leukemia or bone marrow transplantation patients who were hospitalized exclusively in the hematology ward developed invasive pulmonary aspergillosis, although 29% of acute leukemia patients who were housed in a regular ward, because of shortage of space in the new facility, still contracted invasive pulmonary aspergillosis. Overall, 31 patients were diagnosed with invasive pulmonary aspergillosis during almost five years: 74% of patients recovered from invasive pulmonary aspergillosis, and 42% are long-term survivors; 26% of patients died of resistant leukemia with aspergillosis, but no one died of invasive pulmonary aspergillosis alone. In conclusion, during an on-going construction period, an extremely high incidence rate of invasive pulmonary aspergillosis in acute leukemia patients undergoing intensive chemotherapy was observed. Institution of low-dose intravenous amphotericin B prophylaxis marginally reduced the incidence rate of invasive pulmonary aspergillosis. Keeping patients in a special ward with air filtration through a HEPA system eliminated invasive pulmonary aspergillosis completely. Among patients who developed invasive pulmonary aspergillosis, early diagnosis and treatment are probably the explanation for the favorable outcome. Am. J. Hematol. 66:257-262, 2001.

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Section: Discussionmentioning

confidence: 99%

Section: Time Framesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

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Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters

et al. 2001

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“…can disturb bioaerosols that may be impeded and release them into the building. (Arnow, Andersen et al 1978;Loo, Bertrand et al 1996;Pegues, Daar et al 2001;CDC 2003) Therefore, a residual risk of exposure remains, even if the exposure is considered impeded. 4.…”

Section: Assumptionsmentioning

confidence: 99%

An Exposure Model for Identifying Health Risk due to Environmental Microbial Contamination in the Healthcare Setting

Larrañaga¹,

Karunasena²,

Holder³

et al. 2011

Chemistry, Emission Control, Radioactive Pollution and Indoor Air Quality

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“…9 The importance of hospital environment control has been emphasized for effective prevention. The outbreak of nosocomial infections due to the renovation of transplant buildings 10,11 and via the water system in transplant wards has been reported. 12 The CDC guidelines recommend the use of air conditioning systems/tools.…”

mentioning

confidence: 99%

A nationwide survey of deep fungal infections and fungal prophylaxis after hematopoietic stem cell transplantation in Japan

Imataki¹,

Kami²,

Sw³

et al. 2004

Bone Marrow Transplant

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Summary:We conducted a nationwide survey to define incidence of deep fungal infections and fungal prophylaxis practices after HSCT. In all, 63 institutions responded. Total number of in-patient transplantations was 935: 367 autologous, 414 allogeneic myeloablative, and 154 allogeneic reducedintensity (RIST) (n ¼ 154). Number of patients who were cared for in a clean room at transplant was 261 (71%) in autologous, 409 (99%) in conventional and 93 (66%) in RIST, respectively. All patients received prophylactic antifungal agents; 89% fluconazole. Number of patients who received the dosage recommended in the CDC guidelines (400 mg/day) was 135 (42%) in conventional transplant and 34 (30%) in RIST (P ¼ 0.037). Number of patients who received fluconazole until engraftment and beyond day 75 in conventional transplant vs RIST was, respectively, 324 (100%) vs 109 (97%), and 39 (12%) vs 18 (16%), with no significant difference between the two groups. A total of 37 patients (4.0%) were diagnosed with deep fungal infections; autologous transplantation (0.03%), conventional transplantation (6.0%) and RIST (7.1%). Wide variations in antifungal prophylaxis practice according to the type of transplant and the institutions, and deep fungal infection remain significant problems in RIST.

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Control of Construction-Associated Nosocomial Aspergillosis in an Antiquated Hematology Unit

Abstract: An environmental control strategy incorporating widely available technology may have played an important role in controlling this outbreak of construction-associated invasive aspergillosis.

Cited by 100 publications

References 13 publications

Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters

Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters

An Exposure Model for Identifying Health Risk due to Environmental Microbial Contamination in the Healthcare Setting

A nationwide survey of deep fungal infections and fungal prophylaxis after hematopoietic stem cell transplantation in Japan

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