Environmental surveillance and other control measures in the prevention of nosocomial fungal infections

Abstract

The steady world-wide increase in the number of severely immunocompromised patients in most hospitals has made the control and prevention of nosocomial systemic fungal infections a critical quality-of-care standard. Early diagnosis and antifungal prophylaxis of these infections are complicated, so avoiding the acquisition of the pathogen in the case of Aspergillus and minimizing the predisposing risk factors in the case of Candida are more effective approaches. The maintenance of good air quality in critical areas in hospitals is mandatory to reduce the incidence of invasive aspergillosis. We review the currently available Center for Disease Control recommendations and report our own experiences in the field. The indications and problems of fungal environmental and patient surveillance are also discussed.

A survey on distribution and toxigenicity of Aspergillus flavus from indoor and outdoor hospital environments

“…Aflatoxigenic isolates are important from another aspect, i.e., producing aflatoxin-containing airborne conidia as potential causative agents of aflatoxicosis in the hospitals. Possible sources of fungal spores in hospital air are inadequate filtration of outside air, accumulation of spores in dusts in air ducts, vacuum cleaning, carpeting, food spices, and soil of potted ornamental plants, flowers, fresh fruits, and contaminated water and surfaces (Muñoz et al 2001;Panagopoulou et al 2002;VandenBerg et al 1999). So, using the HEPA filters for high-risk rooms, a modification on arrangement and distance from green spaces to wards and control of food and flower entrance by the patient's visitors and relatives to the hospital are suggestive measures which can reduce the chance of fungal spore inhalation in hospital environments.…”

Invasive Fungal Infections and Approaches to Their Diagnosis

“…Although most fungal cultures are performed for the express purpose of making an aetiologic diagnosis of a fungal infection in order to optimise specific antifungal therapy, fungal surveillance cultures have been studied as potential predictors of invasive mycoses in select patient populations (LaRocco & Burgert, 1997;Muñoz, Burillo, & Bouza, 2001;Pfaller, Cabezudo, Koontz, Bale, & Gingrich, 1987;Sandford, Merz, Wingard, Charache, & Saral, 1980;Snydman, 2001). Although active surveillance of high-risk patients may enhance case detection of IC and IA, the data is quite variable (Blumberg et al, 2001;Kusne et al, 1992;Nalesnk, Myerowitz, Jenkins, Lenskey, & Herbert, 1980;Pfaller et al, 1987;Riley, Pavia, Beatty, Denton, & Carroll, 1995;Rogers, Visscher, Bartlett, & Smith, 1985;Saiman et al, 2002;Sandford et al, 1980;Tollemar, Ericzon, Holmberg, & Andersson, 1990;Tollemar, Holmberg, Ringden, & Lonquist, 1989;Yu et al, 1986).…”

Fluconazole and Itraconazole Resistance of Yeasts Isolated from the Bloodstream and Catheters of Hospitalized Pediatric Patients

“…In contrast to previous reports from Argentina and other countries where C. albicans usually exceeds 50% of the isolates, in this report, C. albicans revealed a very low prevalence in blood cultures from oncology patients. Although it was the most prevalent species isolated from blood culture in ICUs, it only accounted for 50% of the cases, revealing non-C. albicans species as predominant opportunistic pathogens [11,[22][23][24][25] .…”