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Efficacy of Prevention by High-Efficiency Particulate Air Filtration or Laminar Airflow Against Aspergillus Airborne Contamination During Hospital Renovation

Published online by Cambridge University Press:  02 January 2015

Muriel Cornet ,
Vincent Levy ,
Laurent Fleury ,
Jacques Lortholary ,
Sandrine Barquins ,
Marie-Hélène Coureul ,
Elisabeth Deliere ,
Robert Zittoun ,
Gilles Brücker  and
Anne Bouvet
Muriel Cornet*
Affiliation:
Service de Microbiologie, Comité de Lutte contre les Infections Nosocomiales, Hôpital Hôtel-Dieu, Paris, France Service Vigilance Hygiène et Prévention, Direction de la Politique Médicale, Assistance Publique-Hôpitaux de paris, Paris, France
Vincent Levy
Affiliation:
Service d'Hématologie, Hôpital Hô-Dieu, Paris, France
Laurent Fleury
Affiliation:
Service Vigilance Hygiène et Prévention, Direction de la Politique Médicale, Assistance Publique-Hôpitaux de paris, Paris, France
Jacques Lortholary
Affiliation:
Service Vigilance Hygiène et Prévention, Direction de la Politique Médicale, Assistance Publique-Hôpitaux de paris, Paris, France
Sandrine Barquins
Affiliation:
Service de Microbiologie, Comité de Lutte contre les Infections Nosocomiales, Hôpital Hôtel-Dieu, Paris, France
Marie-Hélène Coureul
Affiliation:
Service de Microbiologie, Comité de Lutte contre les Infections Nosocomiales, Hôpital Hôtel-Dieu, Paris, France
Elisabeth Deliere
Affiliation:
Service de Microbiologie, Comité de Lutte contre les Infections Nosocomiales, Hôpital Hôtel-Dieu, Paris, France
Robert Zittoun
Affiliation:
Service d'Hématologie, Hôpital Hô-Dieu, Paris, France
Gilles Brücker
Affiliation:
Service Vigilance Hygiène et Prévention, Direction de la Politique Médicale, Assistance Publique-Hôpitaux de paris, Paris, France
Anne Bouvet
Affiliation:
Service de Microbiologie, Comité de Lutte contre les Infections Nosocomiales, Hôpital Hôtel-Dieu, Paris, France
*
Service de microbiologie, Hôtel-Dieu, 1, Place du Parvis Notre-Dame, 75181 Paris Cedex 04, France
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Abstract

Objective:

To evaluate efficacy of laminar airflow facilities plus high-efficiency particulate air (HEPA) filtration and HEPA filtration alone in preventing environmental Aspergillus contamination during hospital renovation. To show the usefulness of environmental surveillance to facilitate protection of patients at risk for invasive pulmonary aspergillosis.

Design:

Prospective sampling of air and surfaces for Aspergillus conidia during 2-year period.

Setting:

A hematological department adjacent to building renovation at a university hospital.

Results:

1,047 air samples and 1,178 surface samples were collected from January 1996 to December 1997. Significantly more air samples were positive for Aspergillus species during the period of building renovation than during the periods before and after renovation in a unit without a protected air supply adjacent to the building work area (51.5% vs 31.7%; odds ratio [OR], 2.3; 95% confidence interval [CI95, 1.4-3.7; P<.001). A major increase in the frequency of positive air samples was also found in another adjacent unit that was protected with HEPA filtration alone (from 1.8% to 47.5%; OR, 48.9; CI95,12-229; P<10-7). In addition, in this unit, the mean count of Aspergillus conidia in positive air samples increased significantly during construction (4 colony-forming units [CFU]/m3 to 24.7 CFU/m3; P=.04) and the proportion of positive surface samples showed a significant increase during renovation (from 0.4% to 9.7%; OR, 28.3; CI95, 3.4-623; P=104). However, none of 142 air samples collected during renovation in the area protected with laminar airflow plus HEPA filtration showed Aspergillus conidia. In a unit distant from the building renovation site, the results of air and surface samples were not affected by renovation.

Conclusion:

This study showed a strong association between building renovation and an increase in environmental Aspergillus contamination. Results confirmed the high efficacy of laminar airflow plus HEPA filtration and a high air-change rate. Although filtration with HEPA was effective during normal conditions, it alone was unable to prevent the rise of Aspergillus contamination related to building renovation. This study emphasized the necessity of an environmental survey of airborne contamination related to construction, to facilitate prevention of nosocomial aspergillosis outbreaks. A standardized protocol for aerobiological surveillance is needed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 7 , July 1999 , pp. 508 - 513
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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References

1.Fridkin, SK, Jarvis, WR. Epidemiology of nosocomial fungal infections. Clin Microbiol Rev 1996;9:499–511.CrossRefGoogle ScholarPubMed
2.Lortholary, O, Dupont, B. Antifungal prophylaxis during neutropenia and immunodeficiency. Clin Microbiol Rev 1997;10:477–504.CrossRefGoogle ScholarPubMed
3.Beyer, J, Schwartz, S, Heinemann, V, Siegert, W. Strategies in prevention of invasive aspergillosis in immunosuppressed or neutropenic patients. Antimicrob Agents Chemother 1994;38:911–917.CrossRefGoogle ScholarPubMed
4.Wald, A, Leisenring, W, van Burik, JABowden, RA. Epidemiology of Aspergillus infections in a large cohort of patients undergoing bone marrow transplantation. J Infect Dis 1997;175:1459–1466.CrossRefGoogle 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.CrossRefGoogle Scholar
6.Saugier-Veber, P, Devergie, A, Sulahian, ARibaud, P, Traore, F, Bourdeau-Esperou, H, et al. Epidemiology and diagnosis of invasive pulmonary aspergillosis in bone marrow transplant patients: results of a 5 year retrospective study. Bone Marrow Transplant 1993;12:121–124.Google ScholarPubMed
7.Iwen, PC, Reed, EC, Armitage, JO, Bierman, PJ, Kessinger, A, Vose, JM, et al. Nosocomial invasive aspergillosis in lymphoma patients treated with bone marrow or peripheral stem cell transplants. Infect Control Hosp Epidemiol 1993;14:131–139.CrossRefGoogle ScholarPubMed
8.Gerson, SL, Talbot, GH, Hurwitz, S, Strom, BL, 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.CrossRefGoogle ScholarPubMed
9.Denning, DW, Stevens, DA. Antifungal and surgical treatment of invasive aspergillosis: review of 2,121 published cases. Rev Infect Dis 1990;12:1147–1201.CrossRefGoogle Scholar
10.Aisner, J, Schimpf, SC, Bennett, JE, Young, VM, Wiernick, PH. Aspergillus infections in cancer patients. Association with fire proofing materials in a new hospital. JAMA 1976;235:411–412.CrossRefGoogle Scholar
11.Arnow, PM, Andersen, RL, Mainous, PD, Smith, EJ. Pulmonary aspergillosis during hospital renovation. Am Rev Respir Dis 1978;118: 49–53.Google Scholar
12.Goodley, JM, Clayton, YM, Hay, RJ. Environmental sampling for aspergilli during building construction on a hospital site. J Hosp Infect 1994;26:27–35.CrossRefGoogle ScholarPubMed
13.Weems, JJ Jr, Davis, BJ, Tablan, OC, Kaufman, L, Martone, WJ. Construction activity: an independent risk factor for invasive aspergillosis and zygomycosis in patients with hematologic malignancy. Infect Control 1987;8:71–75.CrossRefGoogle ScholarPubMed
14.Opal, SM, Asp, AA, Cannady, PB Jr, Morse, PL, Burton, LJ, Hammer, PG IIEfficacy of infection control measures during a nosocomial outbreak of disseminated aspergillosis associated with hospital construction. J Infect Dis 1986;153:634–637.CrossRefGoogle ScholarPubMed
15.Perraud, M, Piens, MANicoloyannis, N, Girard, P, Sepetjan, M, Garin, JR. Invasive nosocomial pulmonary aspergillosis: risk factors and hospital building works. Epidemiol Infect 1987:99:407–412.CrossRefGoogle ScholarPubMed
16.Hruszkewycz, V, Ruben, B, Hypes, CM, Bostic, GB, Staszkiewicz, J, Band, JD. A cluster of pseudofungemia associated with hospital renovation adjacent to the microbiology laboratory. Infect Control Hosp Epidemiol 1992;13:147–150.CrossRefGoogle Scholar
17.Flynn, PM, Williams, BG, Hetherington, SV, Williams, BF, Giannini, MA, Pearson, TA. Aspergillus terreus during hospital renovation. Infect Control Hosp Epidemiol 1993;14:363–364.CrossRefGoogle ScholarPubMed
18.Iwen, PC, Davis, JC, Reed, EC, Winfield, BA, Hinrichs, SH. Airbone 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.CrossRefGoogle Scholar
19.Bryce, EA, Walker, M, Scharf, S, Lim, AT, Walsh, ASharp, N, et al. An outbreak of cutaneous aspergillosis in a tertiary-care hospital. Infect Control Hosp Epidemiol 1996;17:170–172.CrossRefGoogle ScholarPubMed
20.Sessa, A, Meroni, M, Battini, G, Pitingolo, F, Giordano, F, Marks, M, et al. Nosocomial outbreak of Aspergillus fumigatus infection among patients in a renal unit? Nephrol Dial Transplant 1996;11:1322–1324.CrossRefGoogle Scholar
21.Sherertz, RJ, Belani A Kramer, BS, Elfenkin, GJ, Weiner, RS, Sullivan, ML, et al. Impact of air filtration on nosocomial Aspergillus infections.Am J Med 1987;83:709–718.CrossRefGoogle ScholarPubMed
22.Barnes, RA, Rogers, TR. Control of an outbreak of nosocomial aspergillosis by laminar air-flow isolation. J Hosp Infect 1989;14:89–94.CrossRefGoogle ScholarPubMed
23.Streifel, AJ, Lauer, JL, Vesley, D, Juni, B, Rhame, FS. Aspergillus fumigatus and other thermotolerant fungi generated by hospital building demolition. Appl Environ Microbiol 1983;46:375–378.CrossRefGoogle ScholarPubMed
24.Uzun, O, Anaissie, EJ. Antifungal prophylaxis in patients with hematologic malignancies: a reappraisal. Blood 1995;86:2063–2072.CrossRefGoogle ScholarPubMed
25.Krasinski, K, Holzman, RS, Hanna, B, Greco, MAGraff, M, Bhogal, M. Nosocomial fungal infection during hospital renovation. Infect Control 1985;6:278–282.CrossRefGoogle ScholarPubMed
26.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.CrossRefGoogle ScholarPubMed
27.Sarubbi, FA, Kopf, HB, Wilson, MB, McGinnis, MR, Rutala, WA. Increased recovery of Aspergillus flavus from respiratory specimens during hospital construction. Am Rev Respir Dis 1982;1125:33–38.Google Scholar
28.Weber, SF, Peacock, JE, Do, KA, Cruz, JM, Powell, BL, Capizzi, RL. Interaction of granulocytopenia and construction activity as risk factors for nosocomial invasive filamentous fungal disease in patients with hematologic disorders. Infect Control Hosp Epidemiol 1990;11:235–242.CrossRefGoogle ScholarPubMed
29.Arnow, PM, Sadigh, M, Costas, C, Weil, D, Chudy, R. Endemic and epidemic aspergillosis associated with in-hospital replication of Aspergillus organisms. J Infect Dis 1991;164:998–1002.CrossRefGoogle ScholarPubMed
30.Loudon, KW, Coke, AP, Burnie, JP, Lucas, GS, Liu Yin, JA. Invasive aspergillosis: clusters and sources? J Med Vet Mycol 1994;32:217–224.CrossRefGoogle ScholarPubMed
31.Humphreys, H, Johnson, EM, Warnock, DW, Willats, SM, Winter, RJ, Speller, DCE. An outbreak of aspergillosis in general ITU. J Hosp Infect 1991;18:167–177.CrossRefGoogle ScholarPubMed
32.Richet, HM, Mc Neil, MM, Davis, BJ, Duncan, E, Strickler, J, Nunley, D, et al. Aspergillus fumigatus sternal wound infections in patients undergoing open heart surgery. Am J Epidemiol 1992;135:48–58.CrossRefGoogle ScholarPubMed
33.Lajonchere, JP, Feuilhade de Chauvin, M. Contamination aspergillaire: évaluation des mesures de prévention et surveillance de l'environnement. Pathol Biol (Paris) 1994;42:718–729.Google Scholar