title: Efficacy of high-efficiency particulate air filtration in preventing aspergillosis in immunocompromised patients with hematologic malignancies.
abstract: OBJECTIVE
  To describe and investigate the cause of an outbreak of 10 cases of nosocomial invasive infection with Aspergillus flavus in a hematologic oncology patient care unit.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  The hematologic oncology unit of a comprehensive cancer center.
  
  
  METHODS
  Ninety-one patients admitted to the hematologic oncology service between January 1 and December 31, 1992, for 4 or more consecutive days were included in the study.
  
  
  RESULTS
  Ten (18%) of 55 patients admitted from July to December 1992 were diagnosed as having invasive aspergillosis compared with 0 (0%) of 36 patients admitted from January to June 1992 to the same patient care units. Patient characteristics, mortality rate, autopsy rate, and admitting location did not change significantly during the course of the year to result in a sudden increase in the number of aspergillosis cases. The source of the outbreak was the high counts of Aspergillus conidia determined from air sampling in the non-bone marrow transplant wing during the outbreak. After high-efficiency particulate air (HEPA) filters were installed as an infection control measure, there were only two additional cases of nosocomial aspergillosis in the 2 years following the outbreak.
  
  
  CONCLUSIONS
  This outbreak occurred among hematologic oncology patients with prolonged granulocytopenia housed in an environment with neither HEPA filters nor laminar air flow units. Our data demonstrate that in the setting of an outbreak of aspergillosis, HEPA filters are protective for highly immunocompromised patients with hematologic malignancies and are effective at controlling outbreaks due to air contamination with Aspergillus conidia.
authors.affiliation: Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
authors.forename: Theresa
authors.initials: T
authors.lastname: Hahn
authors.forename: K Michael
authors.initials: KM
authors.lastname: Cummings
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Michalek
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Lipman
authors.forename: Brahm H
authors.initials: BH
authors.lastname: Segal
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000389:Air Conditioning / Q000379:methods* / Q000592:standards; D000391:Air Microbiology; D001228:Aspergillosis / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D001231:Aspergillus flavus; D002173:Cancer Care Facilities; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D004784:Environmental Monitoring; D005260:Female; D005374:Filtration / Q000379:methods* / Q000592:standards; D019337:Hematologic Neoplasms / Q000150:complications*; D006749:Hospital Design and Construction; D006801:Humans; D016867:Immunocompromised Host; D017053:Infection Control / Q000379:methods* / Q000592:standards; D008172:Lung Diseases, Fungal / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D009518:New York; D012189:Retrospective Studies; D012307:Risk Factors