Thursday, February 14, 2008

Killer in the NICU

From my adopted college town of Manchester, the sad story of a NICU death likely caused by airborne aspergillus:

"Baby ward hit by fatal infection
A Greater Manchester hospital has temporarily closed its neo-natal unit after a baby died and another suffered a potentially fatal infection.

A premature baby developed an infection from aspergillus, a common airborne fungus, and died in December at Salford Royal Hospital.

A second pre-term baby tested positive for skin aspergillus last week.

The hospital said it had closed the ward as a precaution to establish any "common contributory factors".

The aspergillus fungus is very common and can be found in homes and buildings everywhere, but can cause infections."

Many studies have shown that aspergillus is ubiquitous in the environment. Healthy people can be exposed to it without serious consequences. That is not true for immune compromised patients in ICU areas. So, what to do about it?

How about filtering the air? Hospitals already do that and yet aspergillus persists. How about letting in more fresh air? This strategy will introduce more and potentially different types of aspergillus into the hospital. What about cleaning the HVAC frequently to get rid of pathogens?

Studies have shown that traditional cleaning is not effective, as this report(1) from the ECMM shows:

"It appears that fungal spores are not necessarily removed by cleaning the fans. Even scratching and painting them, to eliminate rust and restore a smooth surface on which fungal spores cannot be retained, does not permit decontamination."

In fact, servicing the HVAC can exacerbate the problem(2):

"Our observations suggest that localized, short-term exposures resulting from disturbance of (aspergillus) reservoirs are comparable to or may even greatly exceed maximum expected routine exposures. Further, these reservoirs may be disturbed not just during construction or renovation, but even during routine maintenance activities (telecommunications cabling, HVAC filter replacement) that require access to ceiling spaces."

It is clear that the unique needs of ICU areas need unique solutions. That's where VIGILAIR® comes in. VIGILAIR® Systems combine filtration and the germicidal effect of UVC. Rather than just trapping aspergillus spores, VIGILAIR® is designed to provide enough UVC exposure (dose) to destroy aspergillus. UV technology disinfects HVAC surfaces and then keeps those areas clean by continuously radiating the reservoirs where microorganisms can thrive.

Once again, we need to be aware than Infection Control is an environmental issue. Diligent IC professionals must recognize and remove all reservoirs for pathogen growth within the hospital. Unfortunately, the HVAC system is frequently overlooked as a reservoir despite the fact that it houses the largest untreated water supply within a health care facility.

1. European Confederation of Medical Mycology Conference 1996. S. Heinemann, G. Van. houte, N. Nolard. Contamination of indoor environment and air conditioning.
2. European Confederation of Medical Mycology Conference 2008. Khan M, Gonsoulin T, Simpson S, Horner WE. Exposure levels of aspergillus fumigatus from various indoor reservoirs in health care facilities.


Anonymous said...

You might want to check out the Genesis Air system here is a few links that might peek your intrest.

Anonymous said...

sorry one link was wrong

Anonymous said...

Upon removal of a breast implant it was noted that there was a black stain or streaking in the tissue adjacent to areas of the breast where the patient was experiencing pain. A culture of tissue from the breast pocket from which the implant was removed grew Asp. Flavus. Was the black stain consistent with, or indicative of, the presence of Asp. Flavus even though when cultured, the color is different?