Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-24T16:30:15.976Z Has data issue: false hasContentIssue false
  • English
  • Français

Control of Construction-Associated Nosocomial Aspergillosis in an Antiquated Hematology Unit

Published online by Cambridge University Press:  02 January 2015

Vivian G. Loo ,
Céline Bertrand ,
Catherine Dixon ,
Debbie Vityé ,
Beverley DeSalis ,
A.P.H. McLean ,
Alan Brox  and
Hugh G. Robson
Vivian G. Loo*
Affiliation:
Infection Control Service, Quebec, Canada Department of Microbiology, Quebec, Canada Royal Victoria Hospital, and the Departments of Medicine, Quebec, Canada
Céline Bertrand
Affiliation:
Infection Control Service, Quebec, Canada
Catherine Dixon
Affiliation:
Infection Control Service, Quebec, Canada
Debbie Vityé
Affiliation:
Department of Project Management, Quebec, Canada
Beverley DeSalis
Affiliation:
Division of Hematology and Medical Oncology, Quebec, Canada
A.P.H. McLean
Affiliation:
Infection Control Service, Quebec, Canada Surgery, McGill University, Montreal, Quebec, Canada
Alan Brox
Affiliation:
Division of Hematology and Medical Oncology, Quebec, Canada Royal Victoria Hospital, and the Departments of Medicine, Quebec, Canada
Hugh G. Robson
Affiliation:
Department of Microbiology, Quebec, Canada Royal Victoria Hospital, and the Departments of Medicine, Quebec, Canada Microbiology and Immunology, Quebec, Canada
*
Department of Microbiology, Royal Victoria Hospital, 687 Pine Ave W, Room L5.06, Montreal, Quebec H3A 1A1, Canada.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: To determine the incidence of aspergillosis in patients with leukemia or bone marrow transplants during a construction-associated outbreak, and the effect of an environmental control program for Aspergillus.

Design: Clinical, microbiological, and pathological records were reviewed retrospectively once the outbreak was appreciated, and prospectively thereafter, to determine the presence or absence of aspergillosis and duration of neutropenia.

Setting: A university tertiary-care center with a single designated hematology-oncology unit.

Patients: From January 1988 to September 1993, there were 141 patients with leukemia or bone marrow transplants identified as being neutropenic during 231 admissions to this specialized unit.

Interventions: Installation of wall-mounted portable high-efficiency particulate air (HEPA)-filter air purifiers, application of copper-8-quinolinolate–formulated paint, replacement of perforated ceiling tiles with nonperforated type, sealing of all windows, replacement of horizontal, dust-accumulating blinds with vinyl, opaque, roller shades, and systematic and regular cleaning of surfaces.

Results: Thirty-six cases of nosocomial aspergillosis were diagnosed during this period. The incidence density (ID) in the preconstruction period was 3.18 per 1,000 days at risk. During construction activity—before the implementation of a control strategy—the ID increased dramatically to 9.88 per 1,000 days at risk. With infection control measures implemented and continued construction work, the ID decreased to 2.91 per 1,000 days at risk, comparable to the preconstruction baseline rate.

Conclusions: An environmental control strategy incorporating widely available technology may have played an important role in controlling this outbreak of construction-associated invasive aspergillosis.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 6 , June 1996 , pp. 360 - 364
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Rhame, FS. Prevention of nososcomial aspergillosis. J Hosp Infect 1991;18(suppl A):466–472.Google Scholar
2.Rhame, FS, Streifel, AJ, Kersey, JH, McGlave, PB. Extrinsic risk factors for pneumonia in the patient at high risk of infection. Am J Med 1984;76:42–51.Google Scholar
3.Opal, SM, Asp, AA, Cannady, PB JrMorse, PL, Burton, LJ, Hammer, PG II. 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
4.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.Google Scholar
5.Carlisle, PS, Gucalp, R, Wiernik, PH. Nosocomial infections in neutropenic cancer patients. Infect Control Hosp Epidemiol 1993;14:320–324.Google Scholar
6.Weems, JJ, 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.Google Scholar
7.Arnow, PM, Andersen, RL, Mainous, PD, Smith, EJ. Pulmonary aspergillosis during hospital renovation. Am Rev Respir Dis 1978;118:49–53.Google Scholar
8.Sheretz, RJ, Belani, A, Kramer, BS, et al.Impact of air filtration on nosocomial Aspergillus infections. Am J Med 1987;83:709–718.Google Scholar
9.Sarubbi, FA JrKopf, HB, Wilson, MB, McGinnis, MR, Rutala, WA. Increased recovery of Aspergillus flavus from respiratory specimens during hospital construction. Am Rev Respir Dis 1982;125:33–38.Google Scholar
10.Aisner, J, Schimpff, SC, Bennett, JE, Young, VM, Wiernick, PH. Aspergillus infections in cancer patients: association with fireproofing materials in a new hospital. JAMA 1976;235:411–412.Google Scholar
11.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
12.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
13.Young, RC, Bennett, JE, Vogel, CL, Carbone, PP, DeVita, VT. Aspergillosis: the spectrum of the disease in 98 patients. Medicine 1970;49:147–173.Google Scholar
14.Yeager, CC. Copper and zinc preser vatives. In: Block, SS, ed. Disinfection, Sterilization, and Preservation. 4th ed. Philadelphia, PA: Lea & Febiger; 1991:358–361.Google Scholar