Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-06T05:23:15.621Z Has data issue: false hasContentIssue false
  • English
  • Français

Failure of the Sterile Air-Flow Component of a Protected Environment Detected by Demonstration of Chaetomium Species Colonization of Four Consecutive Immunosuppressed Occupants

Published online by Cambridge University Press:  21 June 2016

Gail L. Woods ,
J. Calvin Davis  and
William P. Vaughan
Gail L. Woods*
Affiliation:
Departments of Pathology and Microbiology, University of Nebraska Medical Center, 42nd & Dewey Avenue, Omaha, Nebraska
J. Calvin Davis
Affiliation:
Internal Medicine, University of Nebraska Medical Center, 42nd & Dewey Avenue, Omaha, Nebraska
William P. Vaughan
Affiliation:
Internal Medicine, University of Nebraska Medical Center, 42nd & Dewey Avenue, Omaha, Nebraska
*
University of Nebraska Medical Center, 42nd & Dewey Avenue, Omaha, Nebraska 68105
Get access Rights & Permissions [Opens in a new window]

Abstract

Four bone marrow transplant recipients consecutively occupying the same room on our Oncology-Hematology Special Care Unit (OHSCU) became colonized with Chaetomium species between January and April, 1987. These patients, aged 27 to 43 years, were immunocompromised as a result of intensive chemotherapy, and were consequently at increased risk for development of invasive fungal infection. At the time of Chaetomium colonization, all patients were febrile, two had transient new infiltrates on chest x-ray, and three were receiving amphotericin B therapy. Subsequent environmental cultures revealed Chaetomium contamination of the OHSCU air-handling system, including the HEPA (high-efficiency particulate air) filters in seven of the nine rooms comprising the unit. Because fungal colonization of HEPA filters used to create a “protective environment” for immunocompromised patients can occur and can serve as a source for patient infections, guidelines concerning proper surveillance of these HEPA filters should be established. We suggest that before a new patient enters a “protected” room, the clean side of the HEPA filter should be cultured. If fungi are recovered from that culture, we would recommend changing the filter.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 9 , Issue 10 , October 1988 , pp. 451 - 456
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1988

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. Winston, DJ, Gale, RP, Meyer, DV, et al: Infectious complications of human hone marrow transplantation. Medicine 1979; 5X: 1–31.10.1097/00005792-197901000-00001CrossRefGoogle Scholar
2. Gurwith, MJ, Brunton, J. Lank, BA, et al: Granulocytopenia in hospitalized patients. Prognostic factors and etiology of' fever. Am J Med 1978; 64: 121–126.10.1016/0002-9343(78)90187-0CrossRefGoogle Scholar
3. Schimpff, SC, Young, VM, Greene, WH, et al: Origin of infection in acute nonlymphocytic leukemia. Significance of hospital acquisition of potential pathogens. Ann Intern Med 1972; 77:707–714.10.7326/0003-4819-77-5-707CrossRefGoogle ScholarPubMed
4. Preisler, HD, Bjornsson, S: Protected environment units in the treatment of acute leukemia. Semin Oncol 1975; 2:369–377.Google ScholarPubMed
5. Arnow, PM, Andersen, RL, Mainous, PD. et al: Pulmonary aspergillosis during hospital renovation. Am Rev Respir Dis 1978; 118:49–53.Google Scholar
6. Aisner, J, Schimpff, SC. Bennett, JE, et al: Aspergillus infections in cancer patients. Association with fireproofing materials in a new hospital. JAMA 1976; 235:411–412.10.1001/jama.1976.03260300037029CrossRefGoogle Scholar
7. Mahoney, DH, Steuber, CP, Starling, KA, et al: An outbreak of aspergillosis in children with acute leukemia. J Pediatr 1979: 95:70–72.10.1016/S0022-3476(79)80086-4CrossRefGoogle ScholarPubMed
8. Kyriakides, GK, Zinneman, HH. Hall, WH, et al: Immunologic monitoring and aspergillosis in renal transplant patients. Am J Surg 1976; 131:246–252.10.1016/0002-9610(76)90108-2CrossRefGoogle ScholarPubMed
9. Rhame, FS, Streifel, AJ, Kersey, JH. et al: Extrinsic risk factors for pneumonia in the patient at high risk of infection. Am J Med 1984; 76:42–52.10.1016/0002-9343(84)90243-2CrossRefGoogle ScholarPubMed
10. Kr-asinski, K. Holzman, RS, Hanna, B, et al: Nosocomial fungal infection during hospital renovation. Infect Control 19X.5: 6:278–282.Google Scholar
11. Rose, HD, Hirsch, SR: Filtering hospital air decreases Aspergillus spore counts. Am Rev Respir Dis 1979; 119:511–513.Google ScholarPubMed
12. Loveless, MO, Winn, RE, Campbell, M, et al: Mixed invasive infection with Alternaria species and Curvularia species. Am J Clin Pathol 1981; 76:491–493.10.1093/ajcp/76.4.491CrossRefGoogle ScholarPubMed
13. Young, NA, Kwon-Chung, KJ. Kubota, TF, et al: Disseminated infection by Fusarium moniliforme during treatment for malignant lymphoma. J Clin Microbiol 1978; 7:589–594.10.1128/jcm.7.6.589-594.1978CrossRefGoogle ScholarPubMed
14. Chaulk, CP. Smith, PW, Feagler, JR, et al: Fungemia due to Fusarium solani in an immunocompromised child. Pediatr Infect Dis 1986: 5:363–366.10.1097/00006454-198605000-00017CrossRefGoogle Scholar
15. Hoppin, EC, McCoy, EL, Rinaldi, MG: Opportunistic mycotic infection caused by Chaetomium in a patient with acute leukemia. Cancer 1983; 52:555–556.10.1002/1097-0142(19830801)52:3<555::AID-CNCR2820520328>3.0.CO;2-V3.0.CO;2-V>CrossRefGoogle Scholar
16. Bodey, GP. Gehan, EA, Freireich, EJ, et al: Protected environment prophylactic antibiotic program in the chemotherapy of acute leukemia. Am J Med Sci 1971: 262:138–151.10.1097/00000441-197109000-00001CrossRefGoogle ScholarPubMed
17. Schimpff, SC, Greene, WH, Young, VM, et al: Infection prevention in acute nonlymphocytic leukemia. Laminar air-flow room reverse isolation nonabsorbable antibiotic prophylaxis. Ann Intern Med 1975; 82:351–358.10.7326/0003-4819-82-3-351CrossRefGoogle ScholarPubMed
18. Levine, AS, Siegel, SE, Schreiber, AD, et al: Protected environments and prophylactic antibiotics—A prospective controlled study of their utility in the therapy of acute leukemia. N Engl J Med 1973: 288:477–483.10.1056/NEJM197303082881001CrossRefGoogle Scholar
19. Lohner, D, Debusscher, L, Prevost, JM. et al: Comparative randomized study of protected environment plus oral antibiotics versus oral antibiotics alone in neutropenic patients. Cancer Treat Rep 1979; 63:363–368.Google ScholarPubMed
20. Nauseef, WM, Maki, DG: A study of the value of simple protective isolation in patients with granulocytopenia. N Engl J Med 1981; 304:448–453.10.1056/NEJM198102193040802CrossRefGoogle ScholarPubMed
21. Buckner, CD, Clift, RA, Sander, JE, et al: Protective environment for marrow transplant recipients—A prospective study. Ann Intern Med 1978; 89:893–901.10.7326/0003-4819-89-6-893CrossRefGoogle ScholarPubMed
22. Buckner, CD. Clift, RA, Thomas, FD, et al: Early infectious complications in allogeneic marrow transplant recipients with acute leukemia: Effects of prophylactic measures. Infection 1983; 5:243–250.10.1007/BF01641254CrossRefGoogle Scholar
23. Navari, RM, Buckner, CD, Clift, RA, et al: Prophylaxis of infection in patients with aplastic anemia receiving allogeneic marrow transplants. Am J Med 1984; 76:564–572.10.1016/0002-9343(84)90274-2CrossRefGoogle ScholarPubMed
24. Peterson, FB, Buckner, CD. Clift, KA, et al: Laminar air-flow isolation and decontamination: A prospective randomized study of the effects of prophylactic systemic antibiotics in bone marrow transplant patient. Infection 1986; 14:115–121.10.1007/BF01643474CrossRefGoogle Scholar
25. Skinhoj, P, Jacobsen, N, Hoiby, S, et al: Strict protective isolation in allogeneic bone marrow transplantation: Effect on infectious complications, fever and graft versus host disease. Scand J Infect Dis 1987; 19:91–96.10.3109/00365548709032383CrossRefGoogle ScholarPubMed
26. Finegold, SM. Baron, EJ (eds): Diagnostic Microbiology, cd 7. St. Louis, C.V. Mosby Company, 1986.Google Scholar
27. Rippon, JW: Medical Mycology, ed 2. Philadelphia, WB Saunders Company, 1982.Google Scholar
28. Allo, MD, Miller, J, Townsend, T. et al: Primary cutaneous aspergillosis associated with Hickman intravenous catheters. N Engl J Med 1987; 317:1105–1108.10.1056/NEJM198710293171802CrossRefGoogle ScholarPubMed
29. Rubin, KH: The compromised host as sentinel chicken. N Engl J Med 1987: 317:1151–1153.10.1056/NEJM198710293171809CrossRefGoogle ScholarPubMed