Fungi pose greatest threat to bone marrow patients
January 1, 2000 2 minutes read
Fungi pose greatest threat to bone marrow patients
Tips for routine, construction prevention
Infection control professionals should maintain a high index of suspicion for the diagnosis of nosocomial pulmonary aspergillosis in patients who are at high risk for the disease, particularly those with prolonged, severe granulocytopenia, such as bone-marrow-transplant recipients. Patients who have received solid-organ transplants and patients who have hematologic malignancies and are receiving chemotherapy also are at high risk for acquiring the infection, the Cen ters for Disease Control and Prevention advises.
In draft environmental guidelines expected to be finalized this year, the CDC Healthcare Practices Advisory Committee advises some general measures, summarized as follows, to prevent nosocomial aspergillosis:
Aspergillus species are ubiquitous fungi that commonly occur in soil, water, and decaying vegetation. The fungi have been cultured from unfiltered air, ventilation systems, and dust dislodged during hospital renovation and construction. Aspergillus fumigatus and Aspergillus flavus are the most frequently isolated species in patients who have aspergillosis. The most important nosocomial infection caused by Aspergillus species is pneumonia.
Maintain surveillance for cases of nosocomial pulmonary aspergillosis by periodically reviewing the hospital’s microbiologic, histo pathologic, and postmortem data. If a case of nosocomial aspergillosis occurs, begin a prospective search for additional cases in hospitalized patients and an intensified retrospective review of the aforementioned records. If evidence of continuing transmission is not present, continue routine maintenance procedures to prevent nosocomial aspergillosis.
When constructing new specialized-care units for patients at high risk for infection, ensure that patient rooms have adequate capacity to minimize fungal spore counts via maintenance of HEPA filtration; directed room airflow; positive air pressure in patients’ rooms relative to the air pressure in the corridor; properly sealed rooms; and high rates of room-air changes.
During construction or renovation activities:
A. Construct barriers between patient-care and construction areas to prevent dust from entering patient-care areas; these barriers (e.g., plastic or drywall) should be impermeable to Aspergillus species.
B. In construction/renovation areas inside the hospital, create and maintain negative air pressure relative to that in adjacent patient-care areas unless such a pressure differential is contraindicated (e.g., if patients in the adjacent patient-care areas have infectious tuberculosis).
C. Direct pedestrian traffic from construction areas away from patient-care areas to limit the opening and closing of doors or other barriers that might cause dust dispersion, entry of contaminated air, or tracking of dust into patient-care areas.
D. Clean newly constructed areas before allowing patients to enter the areas.
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