The Influence of High-Efficiency Particulate Air Filtration on Mortality and Fungal Infection among Highly Immunosuppressed Patients: A Systematic Review
Author:
Tim Eckmanns, Henning Rüden, and Petra Gastmeier
Date: 1 May 2006
Abstract:
Background. Patients with hematological malignancies who are treated with intensive chemotherapy or whoreceive bone marrow transplants are exposed to an increased risk of developing nosocomial fungal infections. Theaim of this systematic review was to compare the effectiveness of high-efficiency particulate air (HEPA) filtrationwith that of non-HEPA filtration in decreasing the rates of mortality and fungal infection among patients withdiagnosed hematological malignancies and neutropenia or among patients with bone marrow transplants.Methods. Articles identified in a Medline search, guidelines, and books, as well as the bibliographies of reviewarticles, monographs, and the articles identified by Medline, were researched. Randomized trials and observationalstudies comparing HEPA filtration with conventional room ventilation were selected for inclusion in the presentreview.Results. Sixteen trials (9 with death as an outcome and 10 with fungal infection as an outcome) that comparedHEPA filtration with non-HEPA filtration were selected for meta-analyses. We discovered no significant advantagesof HEPA filtration in the prevention of death among patients with hematological malignancies with severe neutropeniain randomized controlled trials (RCTs; relative risk [RR], 0.86 [95% confidence interval {CI}, 0.65-1.14])and in studies of a lower standard (non-RCTs; RR, 0.87 [95% CI, 0.60-1.25]).Conclusions. The placement in protected areas of patients with hematological malignancies with severe neutropeniaor patients with bone marrow transplants appears to be beneficial, but no definitive conclusion could bedrawn from the data available.
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