Air Filtration Protects Against Aspergillus Infections In Hospitalized Patients

D Kontoyiannis and G Bodey. Invasive Aspergillosis in 2002: An update. European Journal of Clinical Microbiology and Infectious Disease 2002;21:161-172.Mayra Menegeuti et al. Assessment of microbiological air quality in hemato-oncology units and its relationship with the occurrence of invasive fungal infections: an integrative review.

Revista da Sociedade Brasileira de Medicinia Tropical Jul-Aug 2013 46(4):391-6.Marie-Paule Fernandez-Gerlinger et al. The Plasmair decontamination system is protective against invasive Aspergillosis in neutropenic patients. Infection Control and Hospital Epidemiology July 2016 Vol 317(7):845-51.

Invasive Aspergillus are all too-common in hospitalized patients and occur in 5 to 25% of patients with leukemia/ lymphoma, 5-30% of bone marrow transplant patients, and 16-27% of lung transplant patients. Even with strong anti-fungal drugs and intense hospital treatment- invasive Aspergillus are fatal from 40 to 90% of the time. Preventing Aspergillus infections is critical in immunocompromised patients. Reducing levels of Aspergillus in hospital air and surfaces may significantly reduce the risk of life threatening invasive Aspergillus infections.

Use of high efficiency particulate air filters (HEPA) have been shown to be useful to reduce rates of hospital invasive Aspergillus infections. A 2013 review of published studies reported that HEPA air filtration significantly reduced levels of hospital airborne Aspergillus and significantly reduced rates of hospital Aspergillus infections in 8 out of 9 (89%) studies. Recently, a sophisticated system has been developed to decontaminate air in hospital rooms called Plasmair®. This system involves a 3-step process which involves air exposure to high electric fields, subsequent ionization, and electrostatic nanofiltration. A 2 year study measured the effectiveness of the Plasmair system in patients with chemotherapy induced immunosuppression (neutropenia) for leukemia, lymphoma, and bone marrow transplants.

Eighty-seven patients were housed mainly in Plasmair rooms and 69 patients were housed mainly in non Plasmair rooms. Risk of invasive Aspergillus infections were significantly more common in patients treated in the non Plasmair rooms (10 out of 69 patients or 14%; with 7 out of 10 cases fatal) as compared to the Plasmair protected rooms (1 out of seven patients or 1.1%, the one case being nonfatal). Microbial sampling included 136 surface samples and 149 air samples in patients rooms. Fungi were more common collected in the non Plasmair rooms versus the Plasmair rooms for both surface samples (5.9% positive vs 0.0% positive) and air samples (19.4% positive vs. 7.3% positive).

Handwashing, proper cleaning of hospital rooms, proper cleaning/disinfection of water systems, avoidance of hospital water/ moisture problems, and adequate patient nutrition can also significantly reduce risk of life threatening hospital infections of Aspergillus, Candida, and other molds.

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