Impact of air filtration on nosocomial aspergillus infections

Sherertz, Robert J.; Belani, Anusha; Kramer, Barnett S.; Elfenbein, Gerald J.; Weiner, Roy S.; Sullivan, Marsha L.; Thomas, Ronald G.; Samsa, Gregory P.

doi:10.1016/0002-9343(87)90902-8

Cited by 318 publications

(124 citation statements)

References 19 publications

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“…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%

“…Group 3-a consisted of 37 AML patients with median length of neutropenia of 16 days (range 5-120), and 8 ALL patients with median of 17 days (range 7-40) of neutropenia. Group 3-b consisted of 23 AML patients with median neutropenia duration of 15 days (range 5-42), and 3 ALL patients with median neutropenia duration of 11 days (range [8][9][10][11][12][13][14][15][16][17][18][19][20]. In group 3-c 26 patients underwent allogeneic BMT in the hematology ward with a median neutropenic period of 15 days (range 9-26), and 168 patients underwent autologous BMT in the hematology ward with median neutropenic period of 10 days (range 7-25).…”

Section: Time Framesmentioning

confidence: 99%

“…Several strategies for the prevention of IPA have been investigated: reduction of environmental exposure using a specialized air-handling system capable of excluding Aspergillus spores, such as HEPA filtration with or without laminar air flow ventilation [3,10,11] which has been very efficacious, augmentation of the natural host defense mechanisms by recombinant growth factors [12], and chemoprophylaxis with intravenous (i.v.) low-dose Amphotericin B (AB) [13][14][15], AB inhalations [16,17], intranasal AB [18,19], or Itraconazole [19], all showed variable success.…”

Section: Introductionmentioning

confidence: 99%

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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: Time Framesmentioning

confidence: 99%

Section: Time Framesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Notably, all viral, four of 10 bacterial and three of five fungal outbreaks Aspergillus is a common airborne infection and outbreaks have been widely reported not only in association with construction activity but also with contamination of water supplies. [11][12][13][14] Outbreaks of infection with other fungi have also been reported, including a series of infections with Paecilomyces lilancinus associated with contaminated skin ointment. 15 Bacterial outbreaks have included waterborne pathogens such Legionella and Pseudomonas species.…”

Section: Infection Outbreaksmentioning

confidence: 99%

“…40 Finally, retrospective studies of the use of HEPA filtration units showed a reduction in the number of Aspergillus organisms in the air and a decrease in the risk of nosocomial Aspergillus infections. 11,13,41 …”

Section: Benefits Of Isolated Environments: Early Studiesmentioning

confidence: 99%

Isolation in the allogeneic transplant environment: how protective is it?

Hayes‐Lattin

Leis

Maziarz

2005

Bone Marrow Transplant

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Summary:Aggressive infection control measures that include isolating patients within protective hospital environments have become a standard practice during allogeneic stem cell transplantation. A wide range of interventions includes the management of ventilation systems, BMT unit construction and cleaning, isolation and barrier precautions, interactions with health-care workers and visitors, skin and oral care, infection surveillance, and the prevention of specific nosocomial and seasonal infections. However, many of these practices have not been definitively proven to provide patients the intended benefit of decreased infection rates or improved survival. Furthermore, each intervention comes with a financial and social cost. With institutional cost containment efforts and recent trials suggesting that patients may be safely cared for in the outpatient environment after allogeneic transplantation, many widely held practices in managing the transplant environment are being reconsidered. With changing practices, transplant teams are encouraged to review local patterns of infections and associated complications and communicate regularly with infection control committees for guidance on the evolution of isolation needs for the immunosuppressed patient.

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Control of Biohazards

Heinsohn¹

2001

Patty's Industrial Hygiene

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Microbes inhabit every environmental niche on the earth, and some have adapted to survival under extremely harsh conditions. Most do not cause disease in humans or animals. Indeed, they have many beneficial uses. Fungi can deteriorate organic materials, including, textiles, leather, wood, foods, paper, and paint. Molds synthesize chemical reagents and medicines and are used in food fermentation, pest control, and other industrial processes. This chapter deals only with microorganisms that can cause occupational disease.

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Impact of air filtration on nosocomial aspergillus infections

Cited by 318 publications

References 19 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

Isolation in the allogeneic transplant environment: how protective is it?

Control of Biohazards

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