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452 An outbreak of invasive Aspergillus flavus infection in a cardiac surgical intensive care unit

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Hiroyuki Kunishima, MD, PhD , Tohoku Univ Graduate School, Sendal, Japan
Kouichi Tokuda, MD, PhD , Tohoku Univ Graduate School, Sendal, Japan
Miho Meguro, RN , Infection control team, Sendai Kosei Hospital, Sendai, Japan
Junichi Chiba, MT , Infection control team, Sendai Kosei Hospital, Sendai, Japan
Tetsuji Aoyagi, MD, PhD , Tohoku Univ Graduate School, Sendal, Japan
Masumitsu Hatta, MD, PhD , Tohoku Univ Graduate School, Sendal, Japan
Miho Kitagawa , Tohoku Univ Graduate School, Sendal, Japan
Keita Kikuchi, MD, PhD , Infection control team, Sendai Kosei Hospital, Sendai, Japan
Yoshihiro Honda, MD, PhD. , Infection control team, Sendai Kosei Hospital, Sendai, Japan
Mitsuo Kaku, MD, PhD , Tohoku Univ Graduate School, Sendal, Japan
Background: Invasive Aspergillus flavus infection and outbreak are rare in health care setting.

Objective: To describe and investigate the cause of an outbreak of nosocomial invasive infection with A. flavus in a cardiac surgical intensive care unit.

Design: Retrospective investigation and detailed environmental assessment.

Setting: Cardiac surgical intensive care unit with 22-beds in a community hospital.

Methods: Cardiac surgical patients with invasive aspergillosis were identified through Retrospective surveillance and confirmed by chart review. Samples for surveillance cultures were obtained from air, health care worker hands, medical devices and other various objects.

Results: Three A. flavus-infected cases identified in the ICU, from July to September 2008. First case had a surgical site infection, second case had a central line associated bloodstream infection and third case had  pneumonia. Large quantities of A. flavus were detected with cultures of air samples taken in the ICU. 75% (15/20) of the health care workers surveyed were demonstrated their hand colonization with A. flavus, while no staff member (0/80) was detected in other departments. The HEPA filter was installed because an A. flavus was detected in a sample from an exhaust port of an air conditioner. However, we could not have any improvement in the results of air sample cultures. Since then, large quantities of A. flavus were detected in a small container of used tealeaves placed as a deodorization near a sink. After removing the used tealeaves from the ICU, A. flavus in air samples had decreased gradually.

Conclusions: We experienced an outbreak due to the A. flavus contamination of used tealeaves. It suggests that it is important to pay attention to not only medical devices or environments deeply associated with patients but also commodities of everyday existence to avoid the infection and outbreaks of the A. flavus.