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Efficacy of High-Efficiency Particulate Air Filtration in Preventing Aspergillosis in Immunocompromised Patients With Hematologic Malignancies

Published online by Cambridge University Press:  02 January 2015

Theresa Hahn ,
K. Michael Cummings ,
Arthur M. Michalek ,
Brian J. Lipman ,
Brahm H. Segal  and
Philip L. McCarthy Jr.
Theresa Hahn*
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York Department of Cancer Prevention, Epidemiology and Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
K. Michael Cummings
Affiliation:
Department of Cancer Prevention, Epidemiology and Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
Arthur M. Michalek
Affiliation:
Department of Educational Affairs, Roswell Park Cancer Institute, Buffalo, New York
Brian J. Lipman
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
Brahm H. Segal
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
Philip L. McCarthy Jr.
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
*
Departments of Medicine and Cancer Prevention, Epidemiology and Biostatistics, Roswell Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263
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Abstract

Objectives:

To describe and investigate the cause of an outbreak of 10 cases of nosocomial invasive infection with Aspergillus flavus in a hematologic oncology patient care unit.

Design:

A retrospective cohort study.

Setting:

The hematologic oncology unit of a comprehensive cancer center.

Patients:

Ninety-one patients admitted to the hematologic oncology service between January 1 and December 31,1992, for 4 or more consecutive days were included in the study.

Results:

Ten (18%) of 55 patients admitted from July to December 1992 were diagnosed as having invasive aspergillosis compared with 0 (0%) of 36 patients admitted from January to June 1992 to the same patient care units. Patient characteristics, mortality rate, autopsy rate, and admitting location did not change significantly during the course of the year to result in a sudden increase in the number of aspergillosis cases. The source of the outbreak was the high counts of Aspergillus conidia determined from air sampling in the non–bone marrow transplant wing during the outbreak. After high-efficiency particulate air (HEPA) filters were installed as an infection control measure, there were only two additional cases of nosocomial aspergillosis in the 2 years following the outbreak.

Conclusions:

This outbreak occurred among hematologic oncology patients with prolonged granulocytopenia housed in an environment with neither HEPA filters nor laminar air flow units. Our data demonstrate that in the setting of an outbreak of aspergillosis, HEPA filters are protective for highly immunocompromised patients with hematologic malignancies and are effective at controlling outbreaks due to air contamination with Aspergillus conidia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 9 , September 2002 , pp. 525 - 531
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Bodey, GP, Vartivarian, S. Aspergillosis. Eur J Clin Microbiol Infect Dis 1989;8:413–437.Google Scholar
2.Meyers, J. Fungal infections in bone marrow transplant patients. Semin Oncol 1990;17:10–13.Google Scholar
3.Lin, S, Schranz, J, Teutsch, S. Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis 2001;32:358–366.Google Scholar
4.Aisner, J, Wiernik, PH, Schimpff, SC. Treatment of invasive aspergillosis: relation of early diagnosis and treatment to response. Ann Intern Med 1977;86:539–543.Google Scholar
5.Pannuti, CS, Gingrich, RD, Pfaller, MA, Wenzel, RP. Nosocomial pneumonia in adult patients undergoing bone marrow transplantation: a 9-year study. J Clin Oncol 1991;9:77–84.Google Scholar
6.Fridkin, SK, Jarvis, WR. Epidemiology of nosocomial fungal infections. Clin Microbiol Rev 1996;9:499–511.Google Scholar
7.Iwen, PC, Reed, EC, Armitage, JO, et al. Nosocomial invasive aspergillosis in lymphoma patients treated with bone marrow or peripheral blood stem cell transplants. Infect Control Hosp Epidemiol 1993;14:131–139.CrossRefGoogle ScholarPubMed
8.Walsh, TJ, Dixon, DM. Nosocomial aspergillosis: environmental microbiology, hospital epidemiology, diagnosis and treatment. Eur J Epidemiol 1989;5:131–142.Google Scholar
9.Rhame, FS. Prevention of nosocomial aspergillosis. J Hosp Infect 1991; 18:466–472.Google Scholar
10.Alberti, C, Bouakline, A, Ribaud, P, et al. Relationship between environmental fungal contamination and the incidence of aspergillosis in haematology patients. J Hosp Infect 2001;48:198–206.Google Scholar
11.Leenders, AC, van Belkum, A, Behrendt, M, Luijendijk, A, Verbrugh, HA. Density and molecular epidemiology of Aspergillus in air and the relationship to outbreaks of Aspergillus infection. J Clin Microbiol 1999;37:1752–1757.Google Scholar
12.Iwen, PC, Davis, JC, Reed, EC, Winfield, BA, Hinrichs, SH. Airborne fungal spore monitoring in a protective environment during hospital construction, and correlation with an outbreak of invasive aspergillosis. Infect Control Hosp Epidemiol 1994;15:303–306.Google Scholar
13.Beck-Sague, CM, Jarvis, WR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980–1990. J Infect Dis 1993;167:1247–1251.Google Scholar
14.Klimowski, LL, Rotstein, C, Cummings, KM. Incidence of nosocomial aspergillosis in patients with leukemia over a twenty-year period. Infect Control Hosp Epidemiol 1989;10:299–305.CrossRefGoogle Scholar
15.Groll, AH, Shah, PM, Mentzel, C, Schneider, M, Just-Nuebling, G, Hebner, K. Trends in the postmortem epidemiology of invasive fungal infections in a university hospital. J Infect 1996;33:23–32.Google Scholar
16.Lentino, JR, Rosenkranz, MA, Michaels, JA, Kurup, VP, Rose, HD, Rytel, MW. Nosocomial aspergillosis: a retrospective review of airborne disease secondary to road construction and contaminated air conditioners. Am J Epidemiol 1982;116:430–437.Google Scholar
17.Sarubbi, FA, Kopf, HB, Wilson, MB, et al. Increased recovery of Aspergillus flavus from respiratory specimens during hospital construction. Rev Respir Dis 1982;125:33–38.Google Scholar
18.Arnow, PA, Andersen, RL, Mainous, PD, Smith, EJ. Pulmonary aspergillosis during hospital renovation. Rev Respir Dis 1978;118:49–53.Google Scholar
19.Thio, CL, Smith, D, Merz, WG, et al. Refinements of environmental assessment during an outbreak investigation of invasive aspergillosis in a leukemia and bone marrow transplant unit. Infect Control Hosp Epidemiol 2000;21:18–23.Google Scholar
20.Cornet, M, Levy, V, Fleury, L, et al. Efficacy of prevention by high-efficiency particulate air filtration or laminar airflow against Aspergillus airborne contamination during hospital renovation. Infect Control Hosp Epidemiol 1999;20:508–513.Google Scholar
21.Loo, VG, Bertrand, C, Dixon, C, et al. Control of construction-associated nosocomial aspergillosis in an antiquated hematology unit. Infect Control Hosp Epidemiol 1996;17:360–364.Google Scholar
22.Opal, SM, Asp, AA, Cannady, PB, Morse, PL, Burton, LJ, Hammer, PG 2nd. Efficacy of infection control measures during a nosocomial outbreak of disseminated aspergillosis associated with hospital construction. J Infect Dis 1986;153:634–637.Google Scholar
23.Peters, WP, Thomann, W, Hunt, D, et al. Nosocomial Aspergillus flavus in a bone marrow transplant unit (BMTU): importance of air surveillance and HEPA filtration. Proceedings of the American Society of Clinical Oncology 1988;7:288.Google Scholar
24.Oren, I, Haddad, N, Finkelstein, R, Rowe, JM. Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: before and after chemoprophylaxis and institution of HEPA filters. Am J Hematol 2001;66:257–262.Google Scholar
25.Aisner, J, Schimpff, SC, Bennett, JE, Young, VM, Wiernik, PH. Aspergillus infections in cancer patients: association with fireproofing materials in a new hospital. JAMA 1976;235:411–412.Google Scholar
26.Rotstein, C, Cummings, KM, Tidings, J, et al. An outbreak of invasive aspergillosis among allogeneic bone marrow transplants: a case-control study. Infect Control 1985;6:347–355.Google Scholar
27.Gerson, SL, Parker, P, Jacobs, MR, Creger, R, Lazarus, HM. Aspergillosis due to carpet contamination. Infect Control Hosp Epidemiol 1994;15:221–223.Google Scholar
28.Gerson, SL, Talbot, GH, Hurwitz, S, Lusk, EJ, Cassileth, PA. Prolonged granulocytopenia: the major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia. Ann Intern Med 1984; 100:345–351.Google Scholar
29.Ascioglu, S, Rex, JH, de Pauw, B, et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002;34:7–14.Google Scholar
30.Yu, VL, Muder, RR, Poorsattar, A. Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillosis: results from a three-year prospective study. Am J Med 1986;81:249–254.Google Scholar
31.Buchheidt, D, Baust, C, Skladny, H, et al. Detection of aspergillus species in blood and bronchoalveolar lavage samples from immunocompromised patients by means of 2-step polymerase chain reaction: clinical results. Clin Infect Dis 2001;33:428–435.Google Scholar
32.Lass-Florl, C, Aigner, J, Gunsilius, E, et al. Screening for Aspergillus spp. using polymerase chain reaction of whole blood samples from patients with haematological malignancies. Br J Haematol 2001;113:180–184.Google Scholar
33.Khan, ZK, Chowdhary, L, Gyanchandani, A, Goswami, M, Farooqui, N, Ranade, SA. Aspergillus fumigatus strains recovered from immunocompromised patients (ICP): subtyping of strains by RAPD analysis. Biochemistry and Molecular Biology International 1998;46:537–548.Google Scholar
34.Brandt, ME, Padhye, AA, Mayer, LW, Holloway, BP. Utility of random amplified polymorphic DNA PCR and TaqMan automated detection in molecular identification of Aspergillus fumigatus. J Clin Microbiol 1998; 36:2057–2062.Google Scholar
35.Sheretz, RJ, Belani, A, Kramer, BS, et al. Impact of air filtration on nosocomial Aspergillus infections: unique risk of bone marrow transplant recipients. Am J Med 1987;83:709–718.Google Scholar
36.Rose, HD, Hirsch, SR. Filtering hospital air decreases Aspergillus spore counts. Am Rev Respir Dis 1979;199:511–513.Google Scholar