Impact of air filtration on nosocomial aspergillus infections: Unique risk of bone marrow transplant recipients

• Published in: The American journal of medicine Vol. 83; no. 4; pp. 709 - 718
• Main Authors: Sherertz, Robert J., Belani, Anusha, Kramer, Barnett S., Elfenbein, Gerald J., Weiner, Roy S., Sullivan, Marsha L., Thomas, Ronald G., Samsa, Gregory P.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.1987; Elsevier
• Subjects: Air Microbiology; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aspergillosis - etiology; Aspergillosis - prevention & control; Biological and medical sciences; Bone Marrow Transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Cross Infection - etiology; Cross Infection - prevention & control; Environment, Controlled; Filtration - instrumentation; Humans; Immune Tolerance; Lung Diseases, Fungal - etiology; Lung Diseases, Fungal - prevention & control; Medical sciences; Risk Factors; Statistics as Topic; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Ventilation; Human; High risk; Homograft; Various treatments; Malignant hemopathy; Fungi; Infection; Prevention; Aspergillus; Autograft; Immunosuppression; Bone marrow; Tumor; Fungi Imperfecti; Thallophyta; Air filtration
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/0002-9343(87)90902-8

Bone marrow transplant recipients were found to have a 10-fold greater incidence of nosocomial Aspergillus infection than other immunocompromised patient populations (p <0.001) when housed outside of a high-efficiency particulate air (HEPA) filtered environment. Multivariate analysis demonstrated that number of infections, age, and graft-versus-host disease severe enough to require treatment were independent risk factors for development of nosocomial Aspergillus infection in this group. The use of whole-wall HEPA filtration units with horizontal laminar flow in patient rooms reduced the number of Aspergillus organisms in the air to 0.009 colony-forming units/m 3, which was significantly lower than in all other areas of the hospital (p ≤0.03). No cases of nosocomial Aspergillus infection developed in 39 bone marrow transplant recipients who resided in this environment throughout their transplantation period compared with 14 cases of nosocomial Aspergillus infection in 74 bone marrow transplant recipients who were housed elsewhere (p <0.001). Thus, although bone marrow transplant recipients had an order-of-magnitude greater risk of nosocomial Aspergillus infection than other immunocompromised hosts, this risk could be eliminated by using HEPA filters with horizontal laminar airflow.