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15 May 2006

Volume 193, Number 10
The Journal of Infectious Diseases 2006;193:1408–1418
© 2006 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2006/19310-0011$15.00
DOI: 10.1086/503435
MAJOR ARTICLE

The Influence of High‐Efficiency Particulate Air Filtration on Mortality and Fungal Infection among Highly Immunosuppressed Patients: A Systematic Review

Tim Eckmanns,1

Henning Rüden,1 and

Petra Gastmeier2

1Institute of Hygiene and Environmental Medicine, Charité–University Medicine Berlin, Berlin, and 2Institute of Microbiology and Hospital Hygiene, Medical University Hanover, Hanover, Germany

Background.Patients with hematological malignancies who are treated with intensive chemotherapy or who receive bone marrow transplants are exposed to an increased risk of developing nosocomial fungal infections. The aim of this systematic review was to compare the effectiveness of high‐efficiency particulate air (HEPA) filtration with that of non‐HEPA filtration in decreasing the rates of mortality and fungal infection among patients with diagnosed 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 review articles, monographs, and the articles identified by Medline, were researched. Randomized trials and observational studies comparing HEPA filtration with conventional room ventilation were selected for inclusion in the present review.

Results.Sixteen trials (9 with death as an outcome and 10 with fungal infection as an outcome) that compared HEPA filtration with non‐HEPA filtration were selected for meta‐analyses. We discovered no significant advantages of HEPA filtration in the prevention of death among patients with hematological malignancies with severe neutropenia in 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 neutropenia or patients with bone marrow transplants appears to be beneficial, but no definitive conclusion could be drawn from the data available.

Received 22 July 2005; accepted 16 December 2005; electronically published 13 April 2006.

Reprints or correspondence: Dr. Tim Eckmanns, Institute of Hygiene and Environmental Medicine, Charité–University Medicine Berlin, Hindenburgdamm 27, 12203 Berlin, Germany ().

Cited by

G. Maschmeyer, S. Neuburger, L. Fritz, A. Bohme, O. Penack, R. Schwerdtfeger, D. Buchheidt, W.-D. Ludwig, . (2009) A prospective, randomised study on the use of well-fitting masks for prevention of invasive aspergillosis in high-risk patients. Annals of Oncology
Online publication date: 18-Jun-2009.
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G. Maschmeyer. (2009) Prevention of mould infections. Journal of Antimicrobial Chemotherapy 63:Supplement 1, i27-i30
Online publication date: 1-Jun-2009.
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E. J. Bow. (2009) Invasive Fungal Infection in Haematopoietic Stem Cell Transplant Recipients: Epidemiology from the Transplant Physician’s Viewpoint. Mycopathologia
Online publication date: 3-May-2009.
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C. C. Chang, E. Athan, C. O. Morrissey, M. A. Slavin. (2008) Preventing invasive fungal infection during hospital building works. Internal Medicine Journal 38:6b, 538-541
Online publication date: 1-Jul-2008.
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Ricardo Araujo, Ana Carneiro, Sofia Costa-Oliveira, Cidalia Pina-Vaz, Acacio Gonçalves Rodrigues, Jose Eduardo Guimaraes. (2008) Fungal infections after haematology unit renovation: evidence of clinical, environmental and economical impact. European Journal of Haematology 80:5, 436-443
Online publication date: 1-Jun-2008.
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L. Zhang, K. Yan, Y. Zhang, R. Huang, J. Bian, C. Zheng, H. Sun, Z. Chen, N. Sun, R. An, F. Min, W. Zhao, Y. Zhuo, J. You, Y. Song, Z. Yu, Z. Liu, K. Yang, H. Gao, H. Dai, X. Zhang, J. Wang, C. Fu, G. Pei, J. Liu, S. Zhang, M. Goodfellow, Y. Jiang, J. Kuai, G. Zhou, X. Chen. (2007) High-throughput synergy screening identifies microbial metabolites as combination agents for the treatment of fungal infections. Proceedings of the National Academy of Sciences 104:11, 4606-4611
Online publication date: 13-Apr-2007.
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Georg Maschmeyer, Antje Haas, Oliver A Cornely. (2007) Invasive Aspergillosis. Drugs 67:11, 1567-1601
Online publication date: 1-Feb-2007.
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Gerald Paul Bodey and Emil J. Freireich. (2006) Influence of High‐Efficiency Particulate Air Filtration on Mortality and Fungal Infection: A Rebuttal. The Journal of Infectious Diseases 194:11, 1621-1622
Online publication date: 1-Dec-2006.
Citation-Full Text-PDF Version (265 kB)
Tim Eckmanns, Henning Rüden, and Petra Gastmeier. (2006) Reply to Bodey and Freireich. The Journal of Infectious Diseases 194:11, 1622-1623
Online publication date: 1-Dec-2006.
Citation-Full Text-PDF Version (265 kB)

  • Potential conflicts of interest: none reported.

    This study was performed within the framework of the Hospital in Europe Link for Infection Control through Surveillance 3 Project (organized by Professor J. Fabry, Lyon, France), supported by the European Community.

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