Biomedical subjects

M Exner

Publications and source records attributed to M Exner.

At least 19 recordsLinked to original sources

PubMed2006

[Infection control and compliance with national recommendations among dentists in Frankfurt/M, Germany: results of a pilot project, 2005].

Recommendations for prevention of infection in dentistry have been published in many countries and in Germany as well. In a pilot project in collaboration with the Public Health Service of the City of Frankfurt and the chamber of dentists in Hesse, compliance with these recommendations was studied in dental practices in Frankfurt/M in 2005. After being informed about the recommendations, more than 50% of the 560 Frankfurt dentists agreed to participate in this project, and 127 of these practitioners were visited by experts of the dentist chamber. Hygienic standards in the practices were examined using a checklist. A proper hygiene schedule was observed in 84% of the practices. Facilities for hand hygiene such as dispensers for soap, disinfectant and towels were available in 98, 93 and 92% of the practices, and personal protective equipment such as gloves, masks, eye wear and gowns was found in 98, 100, 98 and 88% of the practices, respectively. Reprocessing of dental instruments was done either manually (52%), manually in combination with ultrasonic cleaning (48%) or by using special reprocessing machines (32%). Steam sterilization was used in all practices; in some practices gravity displacement sterilizers were used (14%), whereas in most of the practices (61%) a high-speed prevacuum sterilizer was available -- especially in dental surgeon practices (77%). Monitoring and documentation of the sterilization process was done automatically (33%) or by hand (55%). In 80% of the practices, pressure, temperature, time and person responsible were documented. Documents of routine maintenance and regular biological testing of the sterilizers could be shown in 93 and 84% of the practices. The Frankfurt pilot project based on information and advice in combination with control has proven to be successful in the majority of practices enrolled. Encouraged by this experience, the chamber of dentists wants to implement this project all over the state of Hesse. The intention is to inform and to visit all 4,500 dental practices in agreement with the local public health services, which in turn could reduce their own control visits in dental practices. Thus, hygiene control visits of the public health services could focus on other practices such as ambulatory surgery or endoscopy.

Attitude of Health Personnel↗

PubMed2006

Pivotal role of complement-fixing HLA alloantibodies in presensitized kidney allograft recipients.

Recipient presensitization represents a major risk factor for kidney allograft loss. Complement fixation may be a critical attribute of deleterious alloantibodies. We investigated clinical impact of complement-fixing HLA presensitization employing [C4d]FlowPRA, a novel assay permitting selective detection of HLA panel reactive antibody (PRA)-triggered C4 complement split product deposition. A cohort of 338 kidney transplants was evaluated for presensitization applying [C4d]FlowPRA together with [IgG]FlowPRA and complement-dependent cytotoxicity (CDC)-PRA. Analysis of HLA class I alloreactivities revealed a high incidence of C4d-positive graft dysfunction in [IgG]FlowPRA(+)/[C4d]FlowPRA(+) and [IgG]FlowPRA(+)/[C4d]FlowPRA(-) recipients (23% and 22% vs. 3% in [IgG]FlowPRA(-) patients). Only patients with complement-fixing HLA class I immunization had inferior graft survival [75% (3 years) vs. 91% and 89%, respectively (p=0.036)]. Despite frequent finding of capillary C4d deposition (28%), complement-fixing HLA class II immunization was not associated with inferior survival rates. This may have been due to reduction of clinical effects by intense immunosuppression in presensitized patients. Evaluating CDC, 29% of CDC-PRA(+)/[C4d]FlowPRA(+) recipients had C4d-positive graft dysfunction. For these patients 3-year graft survival was worst, followed by CDC-PRA(+)/[C4d]FlowPRA(-) and CDC-PRA(-) patients (76% vs. 81% vs. 90%, p=0.014). Results highlight a strong impact of complement-fixing HLA presensitization. Discerning complement-activating abilities of HLA alloantibodies, [C4d]FlowPRA may help identify recipients at particularly high risk for graft rejection and loss.

Adult↗

PubMed2005

Dermal and bronchial symptoms in children: are they caused by PAH containing parquet glue or by passive smoking?

OBJECTIVE: In 1997 a new source of potential polycyclic aromatic hydrocarbon (PAH) exposure was discovered: very high levels of (PAHs) and benzo-a-pyrene (BaP) were detected in household dust from former American Forces housing in Frankfurt am Main, Germany, built in 1955/1956. This contamination was caused by a parquet glue containing coal tar, the use of which was formerly a standard building practice in Germany. Children were considered to be at special risk for exposure to PAHs when playing on the floor via mouthing. Therefore, the children's symptoms and complaints were analysed for association with PAH contamination in parquet glue and household dust as well as with internal exposure to PAHs via determination of 1-hydroxypyrene in urine samples. PARTICIPANTS AND METHODS: Two hundred and eighty seven children <6 years of age living more than 12 months in the former US-housing estates are enrolled in this analysis, representing 22.3% of the children <6 years of age living there. Their spot urine samples were analysed for 1-hydroxypyrene. The level of BaP in parquet glue and in household dust was available in the homes of 215 and 212 children, respectively. There were no hints for differences in PAH contamination in parquet glue or in household dust of the participants' flats compared to the flats of the non responders. In 246 cases data on environmental tobacco smoke exposure at home was known as well. Data on symptoms and complaints observed by their parents during the preceding 12 months (1-year prevalence) were obtained using the ISAAC questionnaire (modified). RESULTS: The following 1-year prevalences were reported: 15% itching eczema in elbows, 10% itching and urticaria, 6% itching in the palate and throat, 20% sneezing and running nose or stuffed nose, 15% nosebleed; 25% wheezing, 42% dry cough, and 60% frequent infectious disease. No consistent associations between symptoms and BaP in parquet glue or in household dust or urinary levels of 1-hydroxypyrene in the children could be found. However, associations between symptoms and exposure to environmental tobacco smoke at home were to be seen, significant for dermal and bronchial symptoms. CONCLUSION: Informed about PAHs in parquet glue and household dust many parents demanded for total redevelopment of their flats. According to statistical evaluation of the children's symptoms, observed by their parents, no hints for an association with exposure via BaP in parquet glue or household dust were found. However, significant associations between symptoms and the exposure to environmental tobacco smoke were observed, especially bronchial and dermal symptoms. Therefore instead of redevelopment of flats with parquet glue containing coal tar, intensified information on the harmful effects of passive smoking in childhood seems to be mandatory.

Adhesives↗

PubMed2005

[Current hygiene status in endoscopic practice. Results from monitoring the reprocessing of flexible endoscopes in hospitals and private practices in Frankfurt on the Main, Germany, 2003/4].

Flexible endoscopy is essential for the practice of modern medicine. However, with inadequate reprocessing of endoscopes and additional instruments, infections can be transmitted. Therefore, guidelines for reprocessing flexible endoscopes have been published in many countries. The goal of the present survey was to examine the current compliance with German Guidelines in a German urban region, covering all hospitals (15 hospitals) and private practices (23 practices) of this area, without any exception. All endoscopic units in Frankfort on the Main were visited by members of the Public Health Service, using a checklist based on the recommendations of the German Guidelines. In 2004, a reevaluation of 14 hospitals and 20 private practices took place, either by analysing the written reports of the institutions or by revisiting the institutions. In 2003, compliance with the guidelines in hospitals was satisfactory. In practices, however, many problems were identified in 2003. Between 2003 and 2004, great improvements could be seen (data of 2003 in parentheses). At the end of 2004, in 90% of the practices adequate storage of the endoscope without risk of recontamination (2003:52%), correct reprocessing the bottle and the tube for air/water channel flushing including filling with sterilized water was observed (2003:74% and 52%). In 100% of the practices, ultrasonic cleaning (2003:26%) and sterilizing of endoscopic accessories was guaranteed (2003:57%) and routine tests of endoscopes after reprocessing (2003:56%) were performed. In conclusion the relevance and the effect of the advising and control of public health have been so efficient that between 2003 and 2004 most faults have been corrected. Therefore control visits of the Public Health Services should not only cover hygiene in reprocessing the endoscopes but also hygiene in reprocessing endoscopic accessories as well.

Endoscopy↗

PubMed2005

Prevention and control of health care-associated waterborne infections in health care facilities.

The current article is a review of the public health risks attributable to waterborne pathogens in health care. The consequences of health care-associated infections (HAIs) are discussed. Not only are Legionella spp involved in HAIs, but also Pseudomonas aeruginosa, other gram-negative microorganisms, fungi, and amoeba-associated bacteria. This is particularly noteworthy among immunocompromised patients. New prevention strategies and control measures brought about through advanced planning, facility remodelling and reconstruction, disinfection, and filtration have resulted in a significant reduction of the incidence of waterborne HAIs. The positive consequences of a comprehensive multibarrier approach including prevention and control programs in health care facilities are discussed. Environmental cultures are now integrated within the infection control program of some European countries. In high-risk areas, the application of disposable sterile point-of-use filters for faucets and shower heads appears to be the practice of choice to efficiently control waterborne pathogens and to prevent infections.

Biofilms↗

PubMed2005

Prospective surveillance for healthcare-associated infections in German nursing home residents.

We undertook a prospective surveillance study in order to determine the incidence of healthcare-associated infections (HCAIs) in German nursing home residents. All people residing for more than one day in a 103-bed nursing home for the elderly in Bonn, Germany between December 1998 and November 1999 were included. Active surveillance was based on previously published consensus definitions. Rates for HCAIs and urinary tract infections (UTIs) were calculated based on resident-days and device-utilization days, respectively. The overall incidence of HCAIs was 6.0 per 1000 resident-days, with respiratory tract infections, gastroenteritis, skin/soft tissue infections and UTIs representing 94% of all HCAIs (2.2, 1.2, 1.2 and 1.0 infections per 1000 resident-days, respectively). Residents with pneumonia were more likely to die than residents with other HCAIs (RR=5.09; 95%CI 1.87-13.89; P=0.011). We conclude that HCAIs are a serious health problem in German nursing home residents. Standardized surveillance in nursing homes is important to assess the effectiveness of infection control standards, and should be based on consensus definitions in order to allow for meaningful interfacility comparisons. In Germany, the implementation of a hospital reimbursement system based on diagnosis-related groups is likely further to increase the proportion of vulnerable populations in long-term-care facilities.

Aged↗

PubMed2005

Haem oxygenase-1 genotype and cardiovascular adverse events in patients with peripheral artery disease.

BACKGROUND: A functional GT dinucleotide length polymorphism in the haem oxygenase-1 (HO-1) gene promoter is thought to be involved in the pathogenesis of cardiovascular disease. Short (< 25) (GT)n repeats are suggested to facilitate enhanced HO-1 up-regulation in response to injury and confer potent anti-inflammatory and antioxidative effects. MATERIALS AND METHODS: We investigated the association between the HO-1 GT-polymorphism and cardiovascular outcome in 472 patients with advanced peripheral artery disease. Cardiovascular risk profile and DNA samples for determination of the HO-1 genotype (carrier vs. noncarrier of a short (GT)n repeat allele) were obtained at baseline, and patients were followed for median 21 months for the occurrence of coronary events (myocardial infarction, percutaneous coronary interventions and coronary artery bypass graft), cerebrovascular events (stroke or carotid revascularization) and all-cause mortality. RESULTS: Coronary events occurred in 48 patients (9%), cerebrovascular events in 40 patients (9%) and 59 patients (13%) died. In total, 173 major adverse cardiovascular events (MACE) occurred in 133 patients (28%). Carriers of the short (GT)n repeat allele had a 0.46-fold reduced adjusted hazard ratio for coronary events (P = 0.016) as compared to noncarriers. No significant difference was found for cerebrovascular events, mortality and overall MACE. CONCLUSION: Apparently, the HO-1 genotype exerts potentially protective effects against coronary adverse events in patients with peripheral artery disease. Homozygous and heterozygous carriers of < 25 (GT)n repeats had lower rates of myocardial infarction, percutaneous coronary interventions and coronary bypass operations compared to patients with longer (GT)n repeats.

Aged↗

PubMed2005

Peritubular capillary damage in acute humoral rejection: an ultrastructural study on human renal allografts.

The ultrastructural features of peritubular capillary (PC) damage was studied in 12 kidney allografts with acute humoral rejection (AHR). AHR manifested in diffuse linear PC staining for C4d, and histology consistent with Banff grade III in 7 recipients and Banff grade II in 5. Allografts with acute tubular necrosis served as controls. First biopsies (post-transplantation day 16.2 +/- 2.2): The intra-capillary exudate comprised monocytes (59%), polymorphonuclears (14%), lymphocytes (12%) and not otherwise specified mononuclears (15%). Three patterns of focal PC endothelial injury were observed: lysis, an increased rate of apoptosis and fragmentation. No correlation was found between the respective damage types and the inflammatory cell types or the Banff grades. Controls revealed endothelial swelling, detachment from basement membrane and fragmentation. Follow-up biopsies: Monocytes transformed into macrophages intra-luminally. The reparative changes comprised endothelial cytoplasmic protrusions, binucleated endothelial cells and capillary sprouts. Early transplant capillaropathy and transplant glomerulopathy were noted in 2 recipients. Literature data indicate that lysis is mediated by anti-HLA alloantibodies; apoptosis, demonstrated first in the present study, may be induced by non-HLA-type anti-endothelial antibodies. Fragmentation is caused by ischemia. Ongoing endothelial injury leads to transplant capillaropathy and transplant glomerulopathy, the characteristic lesions of chronic rejection.

Acute Disease↗

PubMed2004

Heterotrophic plate count measurement in drinking water safety management: report of an Expert Meeting Geneva, 24-25 April 2002.

A group of microbiology and public health experts including regulatory and medical expertise was convened in Geneva, Switzerland, 25-26 April 2002 to consider the utility of heterotrophic plate count (HPC) measurements in addressing drinking water quality and safety. The group was convened following the NSF International/World Health Organization Symposium on HPC Bacteria in Drinking Water--Public Health Implications? The Expert Meeting was attended by 31 participants from Australia, Canada, France, Germany, Italy, Japan, the Netherlands, South Africa, Switzerland, UK and USA.

Bacteria↗

PubMed2004

Effects of ion-pairing reagents on the electrospray signal suppression of sulphonated dyes and intermediates.

High-performance liquid chromatography/mass spectrometry (HPLC/MS) analysis of anionic species such as sulphonic acid dyes and intermediates requires volatile ion-pairing mobile phase additives. Six di- and trialkylammonium acetates were compared with tetraalkylammonium salts and ammonium acetate in the concentration range 0-20 mmol l(-1) as mobile phase additives for HPLC/MS of polysulphonated compounds. The effects of the structure and concentration of the ion-pairing reagents on the electrospray response of mono-, di- and tetrasulphonic aromatic acids and acid dyes were studied in detail. Further, five different mass analysers and instrument geometries were compared. A higher signal decrease is observed with linear geometry instruments in comparison to orthogonal or even Z-spray geometry mass spectrometers. The concentration of mobile phase additives has a significant influence on the abundance ratios of multiply charged ions in the mass spectra of polysulphonated compounds. The competing ions of sulphonic acids may also cause significant signal suppression.

Journal Article↗

PubMed2004

[Significance of the ordinance on the quality of water for human consumption (Drinking Water Ordinance 2001) for hospital hygiene].

Since January 2003, the new German Drinking Water Ordinance (DWO) has become operative. This paper briefly reviews some major consequences for hospitals. One of the main topics is the increased responsibility of operators of drinking water installation systems in hospitals concerning both the maintenance and control of good drinking water quality. Besides harmful chemical parameters, proliferation of pathogens can occur such as Pseudomonas aeruginosa, Legionella spec., Acinetobacter, and others which are mainly bound to biofilms and thus less affected by disinfectants. Recent epidemiological investigations point out that the relevance of waterborne pathogens is still considerably underestimated, particularly in hospitals. Local public health authorities play a central role in clinic inspection, supervision of water installations, surveillance, and risk assessment in cases of noncompliance with DWO requirements. For this reason, every irregularity detected must be reported to the local public health authority.

Biofilms↗

PubMed2004

[1974-2004: the Commission for Hospital Hygiene has been working for 30 years. From the "old" to the "new" guideline].

After 2 years of preparation, the Commission for Hospital Hygiene, founded in 1974 by the former German Public Health Service, published the "Guideline for Assessment,Prevention, and Controlling of Nosocomial Infections," which represented an exemplarily complete standard for hospital hygiene. In 1997 within the framework of planning the amendment to the Federal Epidemic Law, a new Commission for Hygiene and Infectious Disease Prevention started work and adapted the guideline to meet today's standards of systematic risk analysis and risk management. The amended Infection Protection Act (Infektionsschutzgesetz, IfSG), which came into force in January 2001, installed the Commission for Hospital Hygiene and Infectious Disease Prevention legally and required it to formulate a guideline to decrease the rate of nosocomial infections, the number of outbreaks, and the dissemination of antibiotic-resistant pathogens in healthcare facilities by establishing standards of modern prevention. This article describes the political importance of nosocomial infections for public health as well as the working basis, the methods, and the latest guidelines of the Commission.

Anti-Bacterial Agents↗

PubMed2004

[Parasitic zoonoses transmitted by drinking water. Giardiasis and cryptosporidiosis].

Nowadays, the parasitic zoonose organisms Giardia lamblia und Cryptosporidium spp. are among the most relevant pathogens of drinking water-associated disease outbreaks. These pathogens are transmitted via a fecal-oral route; in both cases the dose of infection is low. Apart from person-to-person or animal-to-person transmissions, the consumption of contaminated food and water are further modes of transmission. The disease is mainly characterized by gastrointestinal symptoms. In industrialized countries, the prevalence rate of giardiasis is 2-5 % and of cryptosporidiosis 1-3%. Throughout the world, a large number of giardiasis and cryptosporidiosis outbreaks associated with drinking water were published; in 2001 the first case in Germany was identified. Giardia and Cryptosporidium are detected in surface water and sporadically in unprotected groundwater. Use of these waters for drinking water abstraction makes high demands on the technology of the treatment process: because of the disinfectant resistance of the parasites, safe elimination methods are needed, which even at high contamination levels of source water guarantee safe drinking water. Further measures for prevention and control are implementation of the HACCP concept, which includes the whole chain of procedures of drinking water supply from catchment via treatment to tap and a quality management system.

Communicable Disease Control↗

PubMed2004

Household cleaning and surface disinfection: new insights and strategies.

Recently, new insights into the persistence of pathogens, their transfer from inanimate surfaces to humans and the risk of contamination and dissemination of pathogens by detergents have been gained. Furthermore, new experimental data on the interruption of chains of infection by disinfectants as well as results of outbreak-control studies are now available. Hence it has become necessary to reassess the potential benefits using disinfectants to prevent and control nosocomial infections. Based on the new findings and in view of the increasing incidence of nosocomial infections and antibiotic resistances, the German Robert-Koch-Institut has issued completely revised recommendations on Household Cleaning and Surface Disinfection. With respect to these recommendations we developed a new test method, which allows comparison of the efficacy of disinfection in reducing the microbial loads and their dissemination with that of cleaning procedures under practical conditions. In a multi-factor approach, mechanical properties (wet mop technique), utensils (different mop materials) and active agents (disinfectant, detergent) were taken into consideration. We found that under the given conditions, dissemination of the test organism Staphylococcus aureus did not take place when using aldehydes and peroxides, it did take place, however, when water, surfactants, and the disinfectants glycol derivatives, quaternary ammonium compounds and alkylamines were used.

Colony Count, Microbial↗

PubMed2004

[Hygiene in endoscopy in the clinic and practice, 2003: Results of infection hygiene survey on endoscopy services in Frankfurt am Main by the public health service].

UNLABELLED: Guidelines for reprocessing flexible endoscopes have been published in many countries. Compliance to the German guidelines, published in 2002 by the Commission on Hospital Hygiene and Infection Prevention on the Robert Koch Institute is mandatory in all endoscopic units, in hospitals as well as in private practices. Here, a survey of current reprocessing practices in an urban region in Germany is published, covering all hospitals and private practices in this region. MATERIAL AND METHODS: In summer 2003, all endoscopic units in Frankfurt/Main, Germany--15 hospitals and 23 private practices -- were visited by members of the public health service, using a checklist based on the recommendations of the German guideline. RESULTS: In these institutions, more than 70 000 endoscopic examinations per year are performed. 87 % (13 /15) of the hospitals and 43 % (10/23) of the practices, reported to conduct more than 1000 procedures per year. Great differences were found in hygienic quality comparing endoscopic units in hospitals and in private practices. In hospitals compliance with the guidelines was satisfactory. Main problems in the practices were: missing facilities for ultrasonic cleaning (74%) and sterilizing (43%), faults in reprocessing the bottle and tube for air/water-channel flushing (26%) which was filled in with water not sterilised (48%), storage of the endoscope with risk of recontamination (48%), missing routine-tests of the endoscopes after reprocessing (44%). Generally, hygienic conditions and procedures were worse in smaller units than in bigger ones. DISCUSSION: The data from Frankfurt hospitals are satisfactory. In private practices, however, especially in smaller ones, improvements are mandatory. Improvements should cover the quality of structure and process, i.e. specific education of the nurses, availability of ultrasonic cleaners and sterilizators and -- preferably -- automatic dishwashers, as well as implementation of a written protocol for hygiene in endoscopy, based on the German Guidelines.

Endoscopes↗

PubMed2004

Cerebrospinal fluid neuron-specific enolase in non-selected patients.

The degree to which cerebrospinal fluid (CSF) neuron-specific enolase (NSE) contributes to the diagnosis and prognosis of disorders of the central nervous system (CNS) or peripheral nervous system (PNS) is still under debate. The aim of the study was thus to assess the validity of CSF-NSE levels in the diagnostic work-up of these conditions. The study consecutively included 106 adult patients who had undergone a diagnostic spinal tap or myelography during the diagnostic work-up for various CNS or PNS disorders. Thirty-five of these patients (16 F, 19 M, aged 24-88 years) without indication of a CNS disorder and with normal routine CSF investigations served as controls. The remaining 71 patients (31 F, 40 M, aged 28-87 years) constituted the disease group. CSF-NSE was independent of sex and age. The upper reference limit of CSF-NSE was 0.01536 ng/L. CSF-NSE was elevated in 13 of the 71 patients (18%): 6 with metabolic myopathy, 4 with polyneuropathy and 3 with hepatic encephalopathy, multiple sclerosis and paraspasticity, respectively. Only 6 of the 13 patients (46%) showed CNS involvement. The study shows that CSF-NSE is elevated in only one-fifth of unselected patients who consecutively undergo a spinal tap. CSF-NSE is elevated most frequently in patients with metabolic myopathy and polyneuropathy, even in cases without CNS abnormalities.

Adult↗

PubMed2004

The size of a microsatellite polymorphism of the haem oxygenase 1 gene is associated with idiopathic recurrent miscarriage.

Endothelial damage, impaired microvascularization and immune maladaptation have been described as aetiological factors in recurrent miscarriages. We investigated the relationship between idiopathic recurrent miscarriage (IRM) and a (GT)(n) repeat microsatellite polymorphism of the gene encoding haem oxygenase 1 (HO-1), known to modulate immune functions such as T-helper (TH) cell function and to be associated with cardiovascular disease. We investigated 162 women with IRM and 129 healthy, post-menopausal controls. The length of the HO-1 (GT)(n) microsatellite was assessed by PCR and direct sequencing in all women. Results were correlated with clinical data. The distribution of genotypes was in Hardy-Weinberg equilibrium. The HO-1 (GT)(n) microsatellite repeat numbers ranged from 13 to 37, with (GT)(23) and (GT)(30) being the most common alleles in both groups. We compared alleles consisting of < or =27 GT repeats, termed class S (short) alleles and alleles consisting of >28 GT repeats, termed class L (long) alleles. Seventy per cent of women with IRM had an S allele either in heterozygous (L/S) or homozygous (S/S) form, compared to 56% of controls (P = 0.02; OR 0.54; 95% CI 0.32-0.90). With respect to S allele frequencies, we found no significant difference among women with IRM and controls [P = 0.3; odds ratio (OR) 1.23, 95% confidence interval (CI) 0.86-1.76]. Comparing women with primary and secondary IRM, no difference with respect to the length of the HO-1 (GT)(n) microsatellite was ascertained. In summary, this is the first report on a HO-1 (GT)(n) microsatellite polymorphism among women with IRM, demonstrating that the investigated polymorphism is associated with IRM in a relatively large Caucasian population.

Abortion, Habitual↗

PubMed2003

Impact of portable air filtration units on exposure of haematology-oncology patients to airborne Aspergillus fumigatus spores under field conditions.

We undertook a one-year study to investigate the impact of the NSA model 7100A/B portable air filtration unit on exposure of haematology-oncology patients to airborne Aspergillus fumigatus spores under field conditions. Weekly measurements for airborne A. fumigatus were conducted in indoor and outdoor air, and surveillance for invasive aspergillosis was based on a combination of ward liaison, targeted chart review and consultation with the medical staff. The mean indoor A. fumigatus counts (8.1 cfu/m3; range, <0.8 to 42 cfu/m3) reflected the fungal load of outdoor air (9.4 cfu/m3; range, <0.8 to 50 cfu/m3), and were reduced by only about one third in rooms with portable air filtration units (5.3 cfu/m3; range, <0.8 to 41 cfu/m3). During the study period, a total of five cases (incidence density, 0.8 per 1000 patient-days) of invasive aspergillosis (one proven case, four suspected cases; case fatality rate 40%) were recorded. None of these five patients was allocated to a room with portable air filtration unit, however, the difference between incidence densities in rooms with and without portable air filtration units was non-significant (Fisher's exact test, P=0.33). Due to the noise level and thermal discomfort, patient compliance with the air filtration units was poor. We conclude that under field conditions this air filtration unit cannot be recommended for prevention of invasive aspergillosis in neutropenic haematology-oncology patients.

Adult↗