Study

Risk Factors

Site

Cause of Outbreak/Reservoir

# of Cases

# of Deaths

Control Measures

Organism

1. Aisner et al

1976

·        Hematologic malignancy

·        Metastatic carcinoma

·        Pulmonary

·        Sinus

·        Fireproofing contaminated during construction of new oncology center

8

At least 3

·        Copper-8-quinonolate

Aspergillus flavus

Aspergillus fumigatus

Aspergillus niger

Aspergillus spp.

2. Lentino et al

1982

·        Hematologic malignancy

·        Renal transplant

recipients

·        Disseminated

·        Road construction

·        Window air conditioners

10

6

·        Not Specified

A. flavus

A. fumigatus

A. niger

A. spp.

3. Opal et al¹

1986

·        Hematologic malignancy

·        High-dose

corticosteroid therapy

·        Carcinoma

·        Disseminated

·        Renovation

·        Construction of existing facility

11

11

·        Copper- 8-quinonolate to decontaminate work area

·        Airtight barriers

·        HEPA filters in patient

        rooms

·        Negative pressure in construction area

·        Traffic between

        construction site and

        patient areas strictly

        controlled

A. flavus

A. fumigatus

A. niger

A. spp.

4. Allo et al

1987

·        Hematologic malignancy

·        Aplastic anemia

·        Primary cutaneous aspergillus

·        Disseminated

·        Contaminated ventilation system in operating room-Johns Hopkins Hospital

9

2

·        Cleaning of ventilation system

A. flavus

5. Ruutu et al

1987

·        Hematologic  malignancy

·        Bone marrow transplant recipients

·        Pulmonary

·        Disseminated

·        Dirty ventilation system

8

6

·        Cleaned ventilation system

·        Cleaned ventilation ducts

and spaces above false

ceiling

·        Fittings around HEPA

filters resealed

·        Fine filters changed

·        Handles removed from

windows

·        Increased speed of

        ventilation fans

A. fumigatus

Author

Risk Factors

Site

Cause of Outbreak/Reservoir

# of Cases

# of Deaths

Control Measures

Organism

6. Perraud et at

1987

·        Hematologic  malignancy

·        Disseminated

·        Construction/renovation

·        Insulation

·        Blinds

22

18

·        Not Specified

A. fumigatus

7. Sherertz et al

1987

($29 million class action lawuit)

·        Bone marrow transplant recipients

·        Disseminated

·        Pulmonary

·        Not specified

14

Not specified

·        Laminar air-flow HEPA filtration

A.  flavus

A. fumigatus

8. Weems et al

1987

·        Advanced age

·        Renal transplant recipients

·        Hematologic

malignancy

·        NICU (colonized cases

        only)

·        Disseminated

·        Skin

·        Major construction with ground site preparation

·        Interior renovation

·        Demolition & modification of HVAC system

Excessive dust from:

·        Demolition and contamination of HVAC system

·        Construction traffic

5

At least 4

·        Windows in patient rooms permanently sealed

A. spp.

Mucormyoses sp.

9. Barnes et al

1989

·        Bone marrow transplant recipients

·        Not specified

·        Construction of existing facility

6

6

·        Laminar air-flow

A. fumigatus

10. Hopkins et al

1989

·        Renal transplantation

·        Hematologic

        malignancy

·        Pulmonary

·        Disseminated

·        Construction in central radiology

·        Unfiltered air in construction area

6

2

·        Renovation completed

A.  fumigatus

11. Arnow et al

1991

·        Hematologic

malignancy

·        Pulmonary

·        Disseminated

·        Contaminated

inanimate  environment

33

Not specified

·        Filters removed

·        Cleaned gaps

·        Environmental cleaning

·        Inspections of water

        damage

A.  flavus

A. fumigatus

12. Flynn et al

1993

·        Bone marrow transplant recipients

·        Hematologic malignancy

·        Disseminated carcinoma

·        Pulmonary

·        Disseminated

·        Renovations 2 floors below ICU

·        Rerouting of duct work

·        Removal of false ceilings

·        Entry through stairwell/ elevator

4

 (2)

infections

(2)

colonizations

4

·        Increased monitoring during outbreak to maintain positive pressure in unit

A. terreus

Author

Risk Factors

Site

Cause of Outbreak/Reservoir

# of Cases

# of Deaths

Control Measures

Organism

13. Loo et al

1996

·        Hematologic malignancy

·        Bone marrow transplant

        recipients

·        Pulmonary

·        Sinus

·        Construction

36

17

·        Portable HEPA filters

·        Copper-8-quinonolate

        applied

·        Windows sealed

·        Ceiling tiles replaced

·        Blinds replaced

·        Ventilation system

        maintained regularly

A. fumigatus

A. flavus

A. niger

14. Thio et al

2000

·        Hematologic malignancy

·        Bone marrow transplant

        recipients

·        Pulmonary

·        Sinus

·        Construction of new oncology center-Johns Hopkins Hospital

29

Not specified

·        Sealed windows and building

·        Redirected traffic

·        Implemented wet mopping

·        Improved cleaning

·        N95 masks

A.  flavus (8)

A. fumigatus

A. niger