Friday, 15 February 2008

Two cases of aspergillosis in premature babies

Mouldy air conditioning unit
No doubting the news of the week - this broke yesterday morning (Thursday 14th Feb)

Infection closes baby unit
BBC ITN news

Aspergillus website and Fungal Research Trust staff contributed expertise to the story and many of the pictures and short movies of growing aspergillus were provided by the Trust (though one or two movies originated here at the Fungal Cell Biology Group in Edinburgh).

One striking feature of this incident is that major building work started at the Salford Royal in September 2007. Any disturbance of the ground causes large amounts of dust to be released into the air, including large amounts of Aspergillus. Building work of this size at Salford Royal would release very large amounts of fungal spores into the air.
Building works adjacent to hospitals have been noted several times to coincide with outbreaks of aspergillus infections - see Barnes et al and a study in France showing the need for increased precautions during building work here.

There is absolutely no suggestion here that Salford Royal or any other UK hospital have failed in their duty to protect vulnerable patients as their precautions are in line with current best practice and even though buildings work is widespread in our hospitals cases of neonatal aspergillosis are thankfully still very rare.

There are several other groups of vulnerable patients e.g. very recent transplant patients, patients being treated for leukemia and other highly immunocompromised patients. These are also at increased risk and cases of aspergillosis in these people are more common - building works having the potential to contribute.

Oddly, there is no UK wide standard protocol or advice to protect vulnerable patients from this increased risk - things as simple as being aware of the risk from building dust and not allowing open windows in wards containing vulnerable patients to the amount of wind on any given day. This is a complex problem.
For the most part it appears in practice that protection is adequate because if it were not there would be many more cases. However there are isolated outbreaks that carry a high risk of having a fatal conclusion.

Head of Estates at Newcastle General Hospital Andrew Poplett has been attempting to push the relevant authorities to establish a standard practice under these circumstances, and many of his suggestions are found here on the Aspergillus Trust website. Perhaps now is the time to take this issue more seriously??

1 comment:

Malcolm Richardson said...

Indeed, a very complex and tragic situation. In the following reference we have attempted to introduce a "standard"/practical guidelines during a very similar construction period to that described in Salford: in essence, prospective particle counting, settled dust analysis, and air sampling for filamentous moulds:

Nihtinen A, Anttila VJ, Richardson M, Meri T, Volin L, Ruutu T.

The utility of intensified environmental surveillance for pathogenic moulds in a stem cell transplantation ward during construction work to monitor the efficacy of HEPA filtration.
Bone Marrow Transplant. 2007; 40:457-60.

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