Hospital Strategies To Prevent Invasive Aspergillosis Spread

SAN DIEGO—Hospitals must adopt environmental policies to help prevent the spread of invasive aspergillosis in high-risk patients, including immunosuppressed cancer patients, Elias Anaissie, MD, of the University of Arkansas, said at a seminar at the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC).

As part of devising a strategy, hospitals must decide which patients are at risk, what that risk is, and how long it persists, he said.

“Unfortunately,” he said, “aspergillosis is ubiquitous in hospitals. It can be found in air, water structures, high-efficiency particulate air (HEPA) filters, and door frames and windows.” Since the hospital setting can be instrumental in helping spread the transmission of aspergillosis in vulnerable patients, even seemingly innocuous activities, such as showering or eating, must be examined.

CDC Recommendations

Among the recommendations made by the Centers for Disease Control and Prevention, Dr. Anaissie cited banning of potted plants, flowers, and carpets from high-risk units, and use of well-sealed rooms, directed room air flow, and HEPA filters (chosen over very expensive laminar airflow, which, he said, studies show are of questionable value).

One of the biggest culprits in the dissemination of aspergillosis in hospitals is water. “Aspergillosis is waterborne. It cannot survive without water,” Dr. Anaissie said, adding that A flumigatus has been found in drinking water.

The CDC recommends the use of sterile drinking water for patients who are immunosuppressed. And he reminded seminar participants that ice machines too must be sterile. Patients can even be exposed by eating certain foods susceptible to mold.

Showering can be a problem because of the spread of the fungus in the shower stall. But sponge baths can be just as problematic. Dr. Anaissie recommends the use of special sponge bath products.

But the bottom line is environmental, he said. “Inspect areas where patients may be exposed,” he emphasized. “But I’m only talking about high-risk patients, not average cancer patients.”