Impact of air filtration on nosocomial aspergillus infections: Unique risk of bone marrow transplant recipients
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...
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Published in | The American journal of medicine Vol. 83; no. 4; pp. 709 - 718 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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New York, NY
Elsevier Inc
01.10.1987
Elsevier |
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Abstract | 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. |
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AbstractList | Bone marrow transplant recipients were found to have a 10-fold greater incidence of nosocomial Aspergillus infection than other immunocompromised patient populations (p less than 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/m3, which was significantly lower than in all other areas of the hospital (p less than or equal to 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 less than 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. 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. |
Author | Weiner, Roy S. Sherertz, Robert J. Samsa, Gregory P. Elfenbein, Gerald J. Thomas, Ronald G. Kramer, Barnett S. Sullivan, Marsha L. Belani, Anusha |
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Keywords | Human High risk Homograft Various treatments Malignant hemopathy Fungi Infection Prevention Aspergillus Autograft Immunosuppression Bone marrow Tumor Fungi Imperfecti Thallophyta Air filtration |
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References_xml | – year: 1987 ident: BIB21 article-title: Method of testing air cleaning devices used in general ventilation for removing particulate matter contributor: fullname: ASHRAE Standard 52–76 – volume: 95 start-page: 70 year: 1979 end-page: 72 ident: BIB9 article-title: An outbreak of aspergillosis in children with acute leukemia publication-title: J Pediatr contributor: fullname: Fernbach – volume: 89 start-page: 893 year: 1978 end-page: 901 ident: BIB16 article-title: Protective environment for marrow transplant recipients publication-title: Ann Intern Med contributor: fullname: Sanders – volume: 288 start-page: 477 year: 1973 end-page: 483 ident: BIB17 article-title: Protected environments and prophylactic antibiotics publication-title: N Engl J Med contributor: fullname: Schreiber – volume: 76 start-page: 42 year: 1984 end-page: 52 ident: BIB15 article-title: Extrinsic risk factors for pneumonia in the patient at high risk of infection publication-title: Am J Med contributor: fullname: McGlave – volume: 90 start-page: 4 year: 1979 end-page: 9 ident: BIB24 article-title: Invasive aspergillosis in acute leukemia: correlation with nose cultures and antibiotic use publication-title: Ann Intern Med contributor: fullname: Steere – volume: 58 start-page: 1 year: 1979 end-page: 31 ident: BIB1 article-title: Infectious complications of human bone marrow transplantation publication-title: Medicine (Baltimore) contributor: fullname: Young – year: 1983 ident: BIB22 article-title: Recommended tentative practice for testing and certification of HEPA filters contributor: fullname: IES RP-CC-001-83-T – volume: 153 start-page: 634 year: 1986 end-page: 637 ident: BIB14 article-title: Efficacy of infection control measures during a nosocomial outbreak of disseminated aspergillosis associated with hospital construction publication-title: J Infect Dis contributor: fullname: Hammer PG – volume: 235 start-page: 411 year: 1976 end-page: 412 ident: BIB8 article-title: Aspergillus infections in cancer patients publication-title: Association with fireproofing materials in a new hospital contributor: fullname: Wiernik – volume: 116 start-page: 430 year: 1982 end-page: 437 ident: BIB5 article-title: Nosocomial aspergillosis publication-title: A retrospective review of airborne disease secondary to road construction and contaminated air conditioners contributor: fullname: Rytel – volume: 19 start-page: 765 year: 1979 end-page: 767 ident: BIB11 article-title: Aspergillus infection of the burn wound publication-title: J Trauma contributor: fullname: McGowan – volume: 6 start-page: 345 year: 1985 end-page: 346 ident: BIB13 article-title: Lessons from the Roswell Park bone marrow transplant aspergillosis outbreak publication-title: Infect Control contributor: fullname: Rhame – volume: 11 start-page: 370 year: 1980 end-page: 376 ident: BIB25 article-title: Significance of Aspergillus species isolated from respiratory secretions in the diagnosis of invasive pulmonary aspergillosis publication-title: J Clin Microbiol contributor: fullname: Herbert – volume: 152 start-page: 572 year: 1985 end-page: 576 ident: BIB26 article-title: Diagnosis of pulmonary infection caused by Aspergillus: usefulness of respiratory cultures publication-title: J Infect Dis contributor: fullname: Smith – start-page: 1447 year: 1985 end-page: 1451 ident: BIB19 article-title: Aspergillus species publication-title: Principles and practice of infectious diseases contributor: fullname: Bennett – year: 1985 ident: BIB18 article-title: Endemic Aspergillus airborne spore levels are a major risk factor for aspergillosis in bone marrow transplant (bone marrow transplant) patients publication-title: 25th Interscience Conference on Antimicrobial Agents and Chemotherapy contributor: fullname: Stevens – volume: 118 start-page: 49 year: 1978 end-page: 53 ident: BIB4 article-title: Pulmonary aspergillosis during hospital renovation publication-title: Am Rev Respir Dis contributor: fullname: Smith – volume: 128 start-page: 541 year: 1971 end-page: 545 ident: BIB7 article-title: Aspergillus infection complicating cardiac transplantation publication-title: Arch Intern Med contributor: fullname: Remington – volume: 101 start-page: 384 year: 1970 end-page: 387 ident: BIB12 article-title: Aspergillus infection after cardiac surgery publication-title: Arch Surg contributor: fullname: Minsley – volume: 64 start-page: 328 year: 1966 end-page: 340 ident: BIB27 article-title: Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia publication-title: Ann Intern Med contributor: fullname: Sathe – year: 1982 ident: BIB23 publication-title: SAS users guide: statistics – volume: 51 start-page: 1087 year: 1978 end-page: 1105 ident: BIB29 article-title: Does graft-versus-host disease influence the tempo of immunologic recovery after allogeneic bone marrow transplantation? 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SubjectTerms | 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 |
Title | Impact of air filtration on nosocomial aspergillus infections: Unique risk of bone marrow transplant recipients |
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