LIVING WITH IT WORKING WITH IT TREATING IT
Background: In our Haematology department, an eighteen beds ward (three units of six beds) benefits from laminar airflow system in order to accommodate patients with bone marrow transplant. Every five years a programmed maintenance works and repairs must be performed, including replacement of terminal filters. Solutions had to be founded to go on with the clinical activity without exposing the patients to fungal risk.
Materials/methods: Works were performed in one unit of six beds at a time. The closed unit was relocated in a temporary ward with no baseline hair handling system but equipped with mobile air decontamination systems Immunair (AirInSpace, Montigny-le-Bretonneux, France) in the bedrooms. At the same time, protective measures were implemented in the two other units, including installation of mobile air decontamination systems Plasmair (AirInSpace). The works were carried out in the three units over a five months period. An accurate planning of every works step was scheduled, including proper patients protections, with a weekly follow-up meeting. To evaluate the effectiveness of the package of measures established, air and surfaces were sampled in the rooms of the Haematology and the temporary wards (Mas100, Merck, France; surface swabbed; cultured on Sabouraud dextrose agar).
Results: In the Haematology ward the fungal air and surfaces contamination of the rooms were low and no different than those outside of works period (2015, 2016, 2017). In the temporary ward air contamination was also comparable, while surface contamination was three to six times as high as those outside of works period (2015, 2016, 2017) in the haematology ward. Nevertheless the only positive surfaces were metallic bars around the Immunair ceiling (14+/39) outside the perimeter of processed air. None of the 60 surfaces sampled near the patient (bedside table, headboard, Immunair curtain) was positive. No nosocomial fungal infection was documented during the follow-up in both wards.
Conclusions: A complicated situation of works in a bone marrow transplant unit was effectively managed by a multidisciplinary team through detailed planning and setting up preventive measures to avoid fungal environmental contamination, including mobile air decontamination systems.
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