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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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