Araújo et al., 20081111. Araújo R, Carneiro A, Oliveira SC, Vaz CP, Rodrigues AG, Guimaraes JE. Fungal
infections after haematology unit renovation: evidence of clinical, environmental and economical
impact. Eur J Haematol 2008; 80:436-443.
|
221 hemato-oncology patients |
Quasi-experimental study (before and after HEPA filter implementation) |
Air fungal counts (from 22-278 to 7 CFU/m33. Warner JK, Wang JCY, Hope KJ, Jin L, Dick JE. Concepts of human leukemic
development. Oncogene 2004; 23:7164-7177.) and fungal infections (from 6.6% to 4.9%) decreased after renovation and HEPA
filter installation |
HEPA filters were effective in reducing both the fungal concentration in the air
and the incidence of fungal infections |
Bénet et al., 20071212. Bénet T, Nicolle MC, Thiebaut A, Piens MA, Nicolini FE, Thomas X, et al.
Reduction of Invasive Aspergillosis Incidence among Immunocompromised Patients after Control of
Environmental Exposure. Clin Infect Dis 2007; 45:682-686.
|
356 intensive-care hemato-oncology patients |
Quasi-experimental study (before and after HEPA filter implementation) |
Invasive aspergillosis incidence decreased from 13.2% to 1.6% after HEPA filter
installation |
HEPA filters were effective in reducing the incidence of fungal infections |
Hahn et al., 20021313. Hahn T, Cummings M, Michalek AM, Lipman BJ, Segal BH, McCarthy PL. Efficacy of
High-Efficiency particulate air filtration in preventing Aspergillosis in immunocompromised patients
with hematologic malignancies. Infect Control Hosp Epidemiol 2002; 23:525-531.
|
91 hemato-oncology patients with a baseline low risk of fungal infection |
Outbreak investigation with a quasi-experimental intervention (before and after
HEPA filter implementation) |
During the outbreak, the Aspergillus air count was >150
CFU/m33. Warner JK, Wang JCY, Hope KJ, Jin L, Dick JE. Concepts of human leukemic
development. Oncogene 2004; 23:7164-7177.. After HEPA filter installation, the count
decreased to <4 CFU/m33. Warner JK, Wang JCY, Hope KJ, Jin L, Dick JE. Concepts of human leukemic
development. Oncogene 2004; 23:7164-7177., which controlled the
outbreak |
HEPA filters were effective in reducing both the fungal concentration in the air
and the incidence of fungal infections |
Alberti et al., 20011414. Alberti C, Bouakline A, Ribaud P, Lacroix C, Rousselot P, Leblanc T, et al.
Aspergillus Study Group. Relationship between environmental fungal contamination and the incidence
of invasive aspergillosis in haematology patients. J Hosp Infect 2001; 48:198-206.
|
Bone marrow transplantation unit and two hematology wards |
Retrospective cohort study comparing rooms with HEPA filters with rooms with
conventional filters (less effective than HEPA filters) |
Of all air samples, 1.1% were positive for Aspergillus spp. in
rooms equipped with HEPA filters, whereas 6.7-9.4% were positive in rooms with conventional filters.
The authors detected a correlation between air contamination and invasive aspergillosis |
HEPA filters were effective in reducing the fungal concentration in the air,
which was correlated with a reduction in the incidence of invasive aspergillosis |
Passweg et al., 19981515. Passweg JR, Rowlings PA, Atkinson KA, Barret AJ, Gale RP, Gratwohl A, et al.
Influence of protective isolation on outcome of allogeneic bone marrow transplantation for leukemia.
Bone Marrow Transplant 1998; 21:1231-1238.
|
5,065 patients with leukemia who underwent allogeneic bone marrow
transplantation |
Quasi-experimental study (before and after HEPA filter implementation) |
Post-transplantation mortality risk due to fungal infections was significantly
lower after HEPA filter installation |
HEPA filters were effective in reducing the incidence of fungal infections and in
improving survival after transplantation |
Hospenthal et al., 19981616. Hospenthal DR, Kwon-Chung KJ, Bennett JE. Concentrations of airborne Aspergillus
compared to the incidence of invasive aspergillosis: lack of correlation. Med Mycol 1998;
36:165-168.
|
Oncology unit with HEPA filters |
Prospective cohort study analyzing the incidence of invasive fungal infections
among rooms with variable concentrations of conidia |
The average fungal concentration was 1.8 CFU/m33. Warner JK, Wang JCY, Hope KJ, Jin L, Dick JE. Concepts of human leukemic
development. Oncogene 2004; 23:7164-7177. for Aspergillus spp., but individual samples reached
concentrations as high as 11.6 CFU/m33. Warner JK, Wang JCY, Hope KJ, Jin L, Dick JE. Concepts of human leukemic
development. Oncogene 2004; 23:7164-7177.. There were
six cases of invasive aspergillosis during the study period |
There was no association between the concentration of conidia and cases of
invasive aspergillosis |