SAN DIEGOHospitals 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.
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 Im
only talking about high-risk patients, not average cancer patients.