MONITORING OF PARTICLE ENVIRONMENTAL POLLUTION AND FUNGAL ISOLATIONS DURING HOSPITAL BUILDING-WORK ACTIVITIES IN A HEMATOLOGY WARD.
Main Article Content
Keywords
renovation activities, dust contamination, invasive aspergillosis, hematology ward, protective measures
Abstract
Building-work activities could cause dust contamination and dissemination of fungal spores. Significant relationship was found between building-work activities and the incidence of invasive aspergillosis, in highly immunocompromised patients.
Renovation-works activities were carried out by four building sites of the hematology ward in a Teaching Hospital without the interruption of clinical activities. These sites were monitored by environmental sampling to determine the particles and fungi count. Clinical surveillance were made using galactomannan antigen test as a proxy for invasive aspergillosis diagnosis.
The galactomannan antigen test showed no significant difference between presence (3,85%) or absence (5,76%) of renovation work activities (p=0,497).
The particle counts showed higher values of small and big-diameter particles before the renovation works if compared to the end of the activities. It was probably due to the containment measures implemented during and immediately after the final phases of the building site. The Fungi counts showed no particular differences between the phase before and after of the renovation activities.
Our finding show that is possible to perform renovation work, during clinical activities, by increasing the clinical and the environmental surveillance.
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References
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Branch, Health Canada PL 0603E1, Ottawa, Ontario, Canada K1A0L2
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concentration
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during hospital construction/renovation works. Journal of Hospital
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invasive fungal disease from the European Organization for Research
and Treatment of Cancer/ Invasive Fungal Infections Cooperative Group
and the National Institute of Allergy and Infectious Diseases Mycoses
Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;
46:1813–1821. https://doi.org/10.1086/588660
25. Patterson TF, Thompson GR, III, Denning DW, et al. Executive
summary: practice guidelines for the diagnosis and management of
aspergillosis: 2016 update by the Infectious Diseases Society of America.
Clin Infect Dis.2016; 63:433– 442. https://doi.org/10.1093/cid/ciw444
26. D’Haese J, Theunissen K, Vermeulen E, et. al. Detection of
galactomannan in bronchoalveolar lavage fluid samples of patients at
risk for invasive pulmonary aspergillosis: analytical and clinical validity.
J Clin Microbiol. 2012; 50:1258 –1263.
https://doi.org/10.1128/JCM.06423-11
27. Rogers TR, Slavin MA, Donnelly JP. Antifungal prophylaxis during
treatment for hematological malignancies: are we there yet? Br J
Haematol 2011;153,681-697.
https://doi.org/10.1111/j.1365-2141.2011.08650.x
28. Ziakas PD, Kourbeti IS, Mylonakis E. Systemic antifungal prophylaxis
after hematopoietic stem cell transplantation: a metaanalysis. Clin Ther
2014; 36:292-306.e1. https://doi.org/10.1016/j.clinthera.2013.11.010
29. Maertens J, Girmenia C, Brüggemann RJ, et al. European guidelines for
primary antifungal prophylaxis in adult haematology patients: summary
of the updated recommendations from the European Conference on
Infections in Leukaemia. J Antimicrob Chemother 2018;73:3221-3230
https://doi.org/10.1093/jac/dky286
30. Iwen PC, Davis JC, Reed EC, Winfield BA, Hinrichs SH. Airborne
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
https://doi.org/10.2307/30146558
31. Haiduven D. Nosocomial aspergillosis and building construction. Med
Mycol 2009;47:210-6. https://doi.org/10.1080/13693780802247694
32. Aspergillosis Subcommittee of the Health Protection Surveillance
Centre Scientific Advisory Committee. National guidelines for the
prevention of nosocomial aspergillosis. 2018.
33. Demiraslan H, Atalay MA, Eren E, Demir K, Kaynar L, Nedret Koc A,
Doganay M. Assessing the risk of false positive serum galactomannan
among patients receiving piperacillin/tazobactam for febrile neutropenia
Medical Mycology 2017; 55, 535–540.
https://doi.org/10.1093/mmy/myw129
34. Graf K, Khani SM, Ott E, Mattner F, Gastmeier P, Sohr D, et al. Fiveyears
surveillance of invasive aspergillosis in a university hospital. BMC
Infect Dis 2011;11:163. https://doi.org/10.1186/1471-2334-11-163
35. Nihtinen A, Anttila VJ, Richardson M, et al. The utility of intensified
environmental surveillance for pathogenic molds in a stem cell
transplantation ward during construction work to monitor the efficacy of
HEPA filtration. Bone Marrow Transplantation 2007; 40, 457–460.
https://doi.org/10.1038/sj.bmt.1705749
invasive Aspergillus infections. F1000Research 2017;6:157.
https://doi.org/10.12688/f1000research.10216.1
2. Alberti C, Bouakline A, Ribaud P, Lacroix C, Rousselot P, Leblanc T,
Deruin F. Relationship between environmental fungal contamination and
the incidence of invasive aspergillosis in hematology patients. J Hosp
Infect 2001;48:198-206. https://doi.org/10.1053/jhin.2001.0998
3. Goodley JM, Clayton YM, Hay RJ. Environmental sampling for
aspergilla during building construction on a hospital site. J Hosp Infect
1994; 26:27-35. https://doi.org/10.1016/0195-6701(94)90076-0
4. Fournel I, Sautour M, Lafon I, Sixt N, L’Ollivier C, Dalle F, Chavanet P,
Couillaud G, Caillot D, Astruc K, Bonnin A, and Aho-Gle´le´ LS, Dijon.
Airborne Aspergillus contamination during hospital construction works:
Efficacy of protective measures. Am J Infect Control 2010;38:189-194.
https://doi.org/10.1016/j.ajic.2009.07.011
5. Leenders AC, van Belkum A, Behrendt M, Luijendijk A, Verbrugh HA.
Density and molecular epidemiology of Aspergillus in air and
relationship to outbreaks of Aspergillus infection. J Clin Microbiol
1999;37:1752-7.
6. Brenier-Pinchart MP, Lebeau B, Quesada JL, et al. Influence of internal
and outdoor factors on filamentous fungal flora in hematology wards.
Am J Infect Control 2009;37:631-7.
https://doi.org/10.1016/j.ajic.2009.03.013
7. Panackal AA, Li H, Kontoyiannis DP et al. Geoclimatic influences on
invasive aspergillosis after hematopoietic stem cell transplantation. Clin
Infect Dis 2010; 50: 1588–1597.
8. Pilmis B, Thepot-Seegers V, C. Angebault C, et al. Could we predict
airborne Aspergillus contamination during construction work? American
Journal of Infection Control 45 (2017) 39-41
https://doi.org/10.1016/j.ajic.2016.08.003
9. Haiduven D. Nosocomial aspergillosis and building construction. Med
Mycol 2009; 47(suppl 1): S210–6
https://doi.org/10.1080/13693780802247694
10. Moscato U, Borghini A, Teleman AA. HVAC Management in Health
Facilities. SpringerBriefs in Public Health, Springer 2017.
https://doi.org/10.1007/978-3-319-49160-8_9
11. Pini G, Faggi E, Donato R, Sacco C, Fanci R. Invasive pulmonary
aspergillosis in neutropenic patients and the influence of hospital
renovation. Mycoses 2008; 51:117–22
https://doi.org/10.1111/j.1439-0507.2007.01453.x
12. Kanamori H, Rutala WA, Sickbert-Bennett EE, Weber DJ. Review of
fungal outbreaks and infection prevention in healthcare settings during
construction and renovation. Clin Infect Dis. 2015 Aug 1; 61(3): 4 -44
https://doi.org/10.1093/cid/civ297
13. Upton A, Kirby KA, Carpenter P, Boeckh M, Marr K. Invasive
aspergillosis following hematopoietic cell transplantation: outcomes and
prognostic factors associated with mortality. Clin Infect Dis 2007; 44:
531–540. https://doi.org/10.1086/510592
14. Neofytos D, Treadway S, Ostrander D et al. Epidemiology, outcomes,
and mortality predictors of invasive mold infections among transplant
recipients: a 10-year, single-center experience. Transpl Infect Dis 2013;
15: 233–242 https://doi.org/10.1111/tid.12060
15. Marr K, Carter R, Crippa F, Wald A, Corey L. Epidemiology and
outcome of mold infections in hematopoietic stem cell transplant
recipients. Clin Infect Dis 2002;34:909–917.
https://doi.org/10.1086/339202
16. Grow W, Moreb J, Roque D, et al. Late onset of invasive Aspergillus
infection in bone marrow transplant patients at a university hospital.
Bone Marrow Transplant 2002;29:1519.
https://doi.org/10.1038/sj.bmt.1703332
17. Zhou W, Li H, Zhang Y, Huang M, He Q, Li P, Zhang F, Shi Y, Su X,
Diagnostic Value of Galactomannan Antigen Test in Serum and
Bronchoalveolar Lavage Fluid Samples from Patients with
Nonneutropenic Invasive Pulmonary Aspergillosis. Journal of Clinical
Microbiology, 2017 ;2153-2161 https://doi.org/10.1128/JCM.00345-17
18. Heng SC, Morrissey O, Chen SC, et al . Utility of bronchoalveolar
lavage fluid galactomannan alone or in combination with PCR for the
diagnosis of invasive aspergillosis in adult hematology patients: a
systematic review and meta-analysis. Crit Rev Microbiol. 2015
Feb;41(1):124-34. https://doi.org/10.3109/1040841X.2013.804033
19. IPAC-Canada. Construction-related infection resources. IPAC – Canada
(http:// www.ipac canada.org/links_construction.php [last accessed April
2019]
20. Health Canada. 2001. Construction-related Nosocomial Infections in
Patients in Health Care Facilities, Decreasing the Risk of Aspergillus,
Legionella and Other Infections, Division of Nosocomial and
Occupational Infections, Bureau of Infectious Diseases, Centre for
Infectious Disease Prevention and Control, Population and Public Health
Branch, Health Canada PL 0603E1, Ottawa, Ontario, Canada K1A0L2
21. J.M. Macher. Positive Hole Correction of MultipleJet-Impactors for
Collecting Viable microorganism. Am. Ind. Hyg. Assoc. J. 1989;50 (11)
561-56. https://doi.org/10.1080/15298668991375164
22. ISO 14644:2015 part 1 Cleanrooms and associated controlled
environments – Part 1: Classification of air cleanliness by particle
concentration
23. Talento AF, Fitzgerald M, Redington B, O’Sullivan N, Fenelon L,
Rogers TR. Prevention of healthcare-associated invasive aspergillosis
during hospital construction/renovation works. Journal of Hospital
Infection 2019;103(1), 1-12. https://doi:10.1016/j.jhin.2018.12.020
24. De Pauw B, Walsh TJ, Donnelly JP, et al.. Revised definitions of
invasive fungal disease from the European Organization for Research
and Treatment of Cancer/ Invasive Fungal Infections Cooperative Group
and the National Institute of Allergy and Infectious Diseases Mycoses
Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;
46:1813–1821. https://doi.org/10.1086/588660
25. Patterson TF, Thompson GR, III, Denning DW, et al. Executive
summary: practice guidelines for the diagnosis and management of
aspergillosis: 2016 update by the Infectious Diseases Society of America.
Clin Infect Dis.2016; 63:433– 442. https://doi.org/10.1093/cid/ciw444
26. D’Haese J, Theunissen K, Vermeulen E, et. al. Detection of
galactomannan in bronchoalveolar lavage fluid samples of patients at
risk for invasive pulmonary aspergillosis: analytical and clinical validity.
J Clin Microbiol. 2012; 50:1258 –1263.
https://doi.org/10.1128/JCM.06423-11
27. Rogers TR, Slavin MA, Donnelly JP. Antifungal prophylaxis during
treatment for hematological malignancies: are we there yet? Br J
Haematol 2011;153,681-697.
https://doi.org/10.1111/j.1365-2141.2011.08650.x
28. Ziakas PD, Kourbeti IS, Mylonakis E. Systemic antifungal prophylaxis
after hematopoietic stem cell transplantation: a metaanalysis. Clin Ther
2014; 36:292-306.e1. https://doi.org/10.1016/j.clinthera.2013.11.010
29. Maertens J, Girmenia C, Brüggemann RJ, et al. European guidelines for
primary antifungal prophylaxis in adult haematology patients: summary
of the updated recommendations from the European Conference on
Infections in Leukaemia. J Antimicrob Chemother 2018;73:3221-3230
https://doi.org/10.1093/jac/dky286
30. Iwen PC, Davis JC, Reed EC, Winfield BA, Hinrichs SH. Airborne
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
https://doi.org/10.2307/30146558
31. Haiduven D. Nosocomial aspergillosis and building construction. Med
Mycol 2009;47:210-6. https://doi.org/10.1080/13693780802247694
32. Aspergillosis Subcommittee of the Health Protection Surveillance
Centre Scientific Advisory Committee. National guidelines for the
prevention of nosocomial aspergillosis. 2018.
33. Demiraslan H, Atalay MA, Eren E, Demir K, Kaynar L, Nedret Koc A,
Doganay M. Assessing the risk of false positive serum galactomannan
among patients receiving piperacillin/tazobactam for febrile neutropenia
Medical Mycology 2017; 55, 535–540.
https://doi.org/10.1093/mmy/myw129
34. Graf K, Khani SM, Ott E, Mattner F, Gastmeier P, Sohr D, et al. Fiveyears
surveillance of invasive aspergillosis in a university hospital. BMC
Infect Dis 2011;11:163. https://doi.org/10.1186/1471-2334-11-163
35. Nihtinen A, Anttila VJ, Richardson M, et al. The utility of intensified
environmental surveillance for pathogenic molds in a stem cell
transplantation ward during construction work to monitor the efficacy of
HEPA filtration. Bone Marrow Transplantation 2007; 40, 457–460.
https://doi.org/10.1038/sj.bmt.1705749