Asp. Outbreak Table

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 falseceiling

·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.

Mucor-myoses 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