title: Impact of portable air filtration units on exposure of haematology-oncology patients to airborne Aspergillus fumigatus spores under field conditions.
abstract: We undertook a one-year study to investigate the impact of the NSA model 7100A/B portable air filtration unit on exposure of haematology-oncology patients to airborne Aspergillus fumigatus spores under field conditions. Weekly measurements for airborne A. fumigatus were conducted in indoor and outdoor air, and surveillance for invasive aspergillosis was based on a combination of ward liaison, targeted chart review and consultation with the medical staff. The mean indoor A. fumigatus counts (8.1 cfu/m3; range, <0.8 to 42 cfu/m3) reflected the fungal load of outdoor air (9.4 cfu/m3; range, <0.8 to 50 cfu/m3), and were reduced by only about one third in rooms with portable air filtration units (5.3 cfu/m3; range, <0.8 to 41 cfu/m3). During the study period, a total of five cases (incidence density, 0.8 per 1000 patient-days) of invasive aspergillosis (one proven case, four suspected cases; case fatality rate 40%) were recorded. None of these five patients was allocated to a room with portable air filtration unit, however, the difference between incidence densities in rooms with and without portable air filtration units was non-significant (Fisher's exact test, P=0.33). Due to the noise level and thermal discomfort, patient compliance with the air filtration units was poor. We conclude that under field conditions this air filtration unit cannot be recommended for prevention of invasive aspergillosis in neutropenic haematology-oncology patients.
authors.affiliation: Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany. steffen.engelhart@ukb.uni-bonn.de
authors.forename: S
authors.initials: S
authors.lastname: Engelhart
authors.forename: J
authors.initials: J
authors.lastname: Hanfland
authors.forename: A
authors.initials: A
authors.lastname: Glasmacher
authors.forename: L
authors.initials: L
authors.lastname: Krizek
authors.forename: I G H
authors.initials: IG
authors.lastname: Schmidt-Wolf
authors.forename: M
authors.initials: M
authors.lastname: Exner
mesh_terms: D000328:Adult; D000391:Air Microbiology; D016902:Air Pollution, Indoor / Q000517:prevention & control*; D001228:Aspergillosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D001232:Aspergillus fumigatus; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004780:Environment, Controlled; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D004867:Equipment Design; D005374:Filtration / Q000295:instrumentation*; D005858:Germany / Q000453:epidemiology; D006405:Hematology; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D019570:Inhalation Exposure / Q000009:adverse effects / Q000517:prevention & control*; D008495:Medical Oncology; D009369:Neoplasms / Q000150:complications; D009503:Neutropenia / Q000150:complications; D010362:Patients' Rooms; D013172:Spores, Fungal