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Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
Published on: March 22, 2012
Aspergillus surveillance project at a large tertiary-care hospital
1Department of Environmental and Occupational Health Science, University of Illinois at Chicago, Chicago, IL 60612, USA. lukec@uic.edu
Abstract:
A one-year surveillance project was conducted at a large tertiary hospital, which had extensive indoor renovation and extensive demolition/building at several nearby sites. This study collected viable fungi samples in the hospital every six days and analysed 74 duct dust samples for Aspergillus fumigatus mycelial asp f1 protein. Mean total fungi were 257.8 cfu/m3 outdoors, 53.2 cfu/m3 in all indoor samples and 83.5 cfu/m3 in the bone marrow transplant patient rooms. Mean total aspergillus was 6.8 cfu/m3 outdoors, 12.1 cfu/m3 in all indoor samples and 7.3 cfu/m3 in the bone marrow transplant patient rooms. The five most prevalent Aspergillus species collected inside the hospital (mean cfu/m3) were Aspergillus niger 7.57 cfu/m3, Aspergillus candidus 1.72 cfu/m3, Aspergillus flavus 0.97 cfu/m3, A. fumigatus 0.88 cfu/m3 and Aspergillus glaucus 0.45 cfu/m3. In rooms undergoing duct cleaning, mean A. fumigatus concentrations were 11.0 cfu/m3. Forty-eight of 74 (65%) duct dust samples had measurable levels of asp f1 protein, with a mean level of 0.41 ppm and maximum level of 1.94 ppm. Three major incidents involved increased hospital aspergillus concentrations. A. niger levels reached 680 cfu/m3 in an organ transplant room after a water leak from a ceiling pipe. Total aspergillus concentrations rose to 77 cfu/m3 in a bone marrow transplant patient room after improper sealing and water infiltration of the unit's dedicated high-efficiency particulate air filter system. Total aspergillus levels of 160 cfu/m3 were recorded in a renovation area during wood cutting. The higher concentrations of aspergillus seen inside the hospital compared with outdoors and the various moisture/HEPA filter/renovation incidents suggest that numerous small to moderate sources of aspergillus exist in the hospital.
Insights
Hospital renovations and nearby construction increased indoor Aspergillus levels, posing risks to patients. Monitoring detected Aspergillus niger and Aspergillus fumigatus, highlighting the need for better environmental controls in healthcare settings.
Area of Science:
- Environmental microbiology
- Hospital infection control
- Air quality monitoring
Background:
- Hospital renovations and nearby construction activities can potentially impact indoor air quality.
- Fungal contamination, particularly Aspergillus species, is a concern in healthcare environments, especially for immunocompromised patients.
Purpose of the Study:
- To conduct a one-year surveillance of viable fungi and Aspergillus species in a tertiary hospital.
- To analyze Aspergillus fumigatus specific marker (asp f1 protein) in duct dust.
- To identify sources and incidents contributing to elevated Aspergillus levels.
Main Methods:
- Collected viable fungi samples bi-weekly over one year.
- Analyzed 74 duct dust samples for Aspergillus fumigatus asp f1 protein.
- Compared indoor fungal concentrations with outdoor levels and identified specific Aspergillus species.
Main Results:
- Indoor Aspergillus levels were higher than outdoor levels.
- Aspergillus niger was the most prevalent species, followed by Aspergillus candidus, Aspergillus flavus, Aspergillus fumigatus, and Aspergillus glaucus.
- Elevated Aspergillus concentrations were linked to specific incidents: water leaks, HEPA filter infiltration, and renovation activities like wood cutting.
Conclusions:
- The study identified multiple sources of Aspergillus contamination within the hospital environment.
- Renovation, water damage, and compromised air filtration systems significantly contribute to increased Aspergillus levels.
- Enhanced environmental monitoring and control measures are crucial for patient safety in healthcare facilities undergoing construction or renovation.
