Association of hospital construction with the development of healthcare associated environmental mold infections (HAEMI) in pediatric patients with leukemia

Abstract

Background Healthcare associated mold infections (HAEMI) increase morbidity and mortality in children with leukemia. Excavation adjacent to Children’s Medical Center Dallas (CMCD) April 2006–February 2007 provided an opportunity to determine if excavation adjacent to a hospital building is associated with increased risk of developing HAEMI in children receiving intensive chemotherapy for acute leukemia. Methods Children who began receiving intensive chemotherapy for acute leukemia at CMCD from 2004–2008 were identified (N=275). Exposures to the CMCD campus during intensive chemotherapy and duration of neutropenia per exposure were recorded. Proven, probable or possible invasive fungal disease (IFD) was classified using EORTC/MSG guidelines. Institutional guidelines categorized mold infections as definite or possible HAEMI. A bivariate time-to-event model compared the association of excavation with HAEMI and yeast infections, controlling for neutropenia. Results There were 7454 CMCD exposures, 1007(13.5%) during excavation. Of 50 cases of IFD, 31 were HAEMI. By time-to-event analysis exposure to the CMCD campus during the excavation period was significantly associated with HAEMI (HR=2.8, P=0.01) but not yeast infections (HR=0.75, P=0.75). Neutropenia was significantly associated with both HAEMI and yeast infections (P<0.001). Voriconazole prophylaxis did not prevent HAEMI in 42% of the 14 patients with AML who had been receiving this agent. Conclusion This study is the first to demonstrate an association between exposure to hospital construction that includes excavation and HAEMI in pediatric oncology patients. Since neutropenic patients need protection from aerosolized fungal spores during visits to expanding medical centers, preventive strategies with adherence monitoring need additional study.

Mold contamination in a controlled hospital environment: a 3-year surveillance in southern Italy

“…Pini et al [ 33 ], during a surveillance of hematology wards, found extremely low concentrations of A. fumigatus in the rooms and corridors and no cases of invasive aspergillosis. More recently, Pokala et al [ 14 ] demonstrated a correlation between a high number of airborne fungal spores and cases of invasive aspergillosis in an onco-hematology pediatric ward that underwent building renovations.…”

“…The air and surfaces in high-risk environments have been often studied as a source of bacterial infection [ 8 ]-[ 10 ], but regarding fungal contamination, the literature data are still limited [ 11 ]-[ 14 ]. The most common infection in fatal complications is aspergillosis in patients with hematological malignancies [ 15 ] and mucormycosis in patients with uncontrolled diabetes mellitus [ 16 ],[ 17 ].…”

Is fumigation enough for air conditioning units in operation theatres and Intensive care units?

“…Similarly, patients admitted in ICUs are also at high risk of acquiring infections from hospital pathogens, which makes it necessary to maintain a strict aseptic condition in the ICUs. 20,21 Most sophisticated operation theatres rely on laminar air flow maintained by air conditioning units attached to HEPA filters, for providing a conducive indoor air with limited number of microorganisms, especially where complicated procedures like implant surgeries take place. 22,23 Similarly, many ICUs use Air Decontaminating Units to filter the air in order to provide a sterile atmosphere besides relying on the ACs for enabling adequate exchange of purified air.…”

Hospital Epidemiology and Infection Control in the Transplant Center

“…Use of HEPA filtration is especially important when construction is conducted within or near the hospital. A heightened risk to immune-compromised patients comes from the aerosolization of mold spores during construction within or in proximity to a hospital, and outbreaks of healthcare-associated environmental mold infections have occurred in relation to adjacent construction in hospitalized immune-compromised patients [69].…”