21
Aspergillus fungus can cause an infection called
aspergillosis.
NOTES FOR SLIDE 25
Aspergillus fungus can cause an
infection called aspergillosis. This
disease usually affects people with
weakened immune systems, such as
hospital patients. A less-serious form
of aspergillosis causes allergic
symptoms like coughing and
wheezing, but doesn’t invade the
body and destroy tissues.
Invasive aspergillosis most commonly causes lung disease, but it can spread
throughout the body and infect other organs. Aspergillosis is usually caused by
inhaling aspergillus spores. The very small size of aspergillus spores lets them
settle deep into the lungs. A hospital patient could also become infected by
spores on dust particles falling out of the air into an open wound or surgical
incision.
According to a 2006 report in the Journal of Hospital Infections*, medical
researchers who traced aspergillosis outbreaks in hospitals found that almost
half of those infections were related to construction activity in the hospital. Dust is
a prime carrier of aspergillus spores, and construction activities create dust. This
is why ICRA procedures to control dust are so critical.
*(The Journal of Hospital Infection July 2006 Volume 63, Issue 3, Pages 246
–
254)
Legi
onella is a bacterium that can cause Legionnaires’
disease.
NOTES FOR SLIDE 26
These bacteria were named in 1976,
when many people who went to an
American Legion convention in
Philadelphia got sick from this
disease.
Among more than 2,000
attendees of a Legionnaires'
convention held at the Bellevue-
Stratford Hotel, 221 attendees
contracted the disease and 34 of them died.
22
Legionnaires' disease is transmitted by inhalation of
water mist or vapor and/or
soil contaminated with the
Legionella
bacteria. Legionnaires' disease is not
transmitted from person to person.
The
length of time between exposure to the bacteria and the appearance of
symptoms
is generally two to 10 days, but can extend to as much as 20 days.
For those in the hospital, between 0.4 to 14% exposed to the bacteria will
develop the disease. While among those in the general population exposed,
between 0.1 to 5% will develop the disease.
Legionella can be found throughout healthcare facilities.
NOTES FOR SLIDE 27
Legionella bacteria are found
naturally in the environment, usually
in warm water. Sources where
temperatures allow the bacteria to
thrive include hot-water tanks,
cooling towers, evaporative
condensers of large air-conditioning
systems, and even decorative fountains, such as those commonly found in
hospitals.
During construction projects, hospital water systems are often disrupted. If the
water is shut off, there could be legionella bacteria that were harmlessly stuck to
the inside of a pipe that come loose when the water is turned back on. Shutting
off some of the water during construction could create a dead end in the system,
allowing water to stagnate and bacteria to multiply.
In 2015, five cooling towers in the South Bronx NY tested positive for legionella
—
including towers at the Lincoln Medical and Mental Health Center. None of the
people who became ill had been patients or staff members at Lincoln Medical
and Mental Health Center. The towers at all five contaminated sites were flushed
and cleaned with antibacterial solutions to decontaminate and sterilize them.
23
The reservoir is the environment in which the pathogen
is found.
NOTES FOR SLIDE 28
Only show the title of the
PowerPoint slide
“The reservoir is
the environment in which the
pathogen is found
.”
Construction projects uncover
reservoirs
of disease producing
pathogens during demolition,
renovation, maintenance and construction; the risk for transmittal must be
identified prior to starting any work.
ASK THE CLASS:
Can you think of any areas in a hospital that would be considered a reservoir?
Write the participant responses on a whiteboard or flipchart.
Click on the PowerPoint to reveal the suggested areas. Compare the list the
class generated with the list from the PowerPoint.
ASK THE CLASS:
Are there any new areas they have thought of after seeing the PowerPoint?
Add them to your whiteboard or flip chart.
Review the following areas as a minimum number of areas considered to
be reservoirs:
Behind drywall
Ceilings/Plenum spaces
Ductwork
Plumbing systems
Cooling towers