EC 10 - Unearthing the Mold: An Investigation of Hospital-associated Mold Infections in a Medical Intensive Care Unit

Tuesday, June 27, 2023

3:11 PM – 3:30 PM

Location: W103 A/B; Orange County Convention Center

CE: .33

CNE Credits: 0.33
CME Credits: 0.33

Presenter(s)

Carey Dombecki, MPH, CIC (she/her/hers)

Senior Infection Preventionist
University of Michigan Health
Ann Arbor, Michigan

Disclosure(s): No financial relationships to disclose

PDF

Co-Author(s)

Harry Zhen, MPH, CIC (he/him/his)

Infection Preventionist
University of Michigan Health
Ann Arbor, Michigan
Nsikak Ubon-Isreal, MPH, CPH

Infection Preventionist
University of Michigan Health, Michigan
Jeffrey Chludzinski, MPH, CIC, MB(ASCP)CM (he/him/his)

Senior Infection Preventionist
University of Michigan Health
Ann Arbor, Michigan
Kristen VanderElzen, MPH, CIC

Infection Prevention and Epidemiology, Project Manager
University of Michigan Health
Ann Arbor, Michigan
Anastasia Wasylyshyn, MD

Associate Hospital Epidemiologist, Infection Prevention
Michigan Medicine
Ann Arbor, Michigan
Amanda M. Valyko, MPH, CIC, FAPIC

Director, Infection Prevention & Epidemiology
University of Michigan Health
Ann Arbor, MI
LW

Laraine Washer, MD

Hospital Epidemiologist
University of Michigan Health
Ann Arbor, Michigan

Moderator(s)

Lauren Le Goff, MS, MLS(ASCP), CIC, FAPIC (she/her/hers)

Manager, Infection Prevention
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania

Disclosure(s): No financial relationships to disclose

Co-Moderator(s)

Molly Hale, MPH, CIC, FAPIC (she/her/hers)

Manager, Infection Prevention
PeaceHealth
Springfield, Oregon

Disclosure(s): No financial relationships to disclose

Background: COVID-19 associated pulmonary aspergillosis (CAPA) has been frequently described in ICU patients with risk attributed to structural lung injury and immunosuppression. Immunosuppressive therapies including steroids and interleukin-6 receptor inhibitors are a frequent treatment for severe COVID-19 infection. The use of negative pressure environments may also increase risk of exposure to mold from the environment outside of the patient room. To meet the demand for COVID-19 care at our facility, patient rooms were retrofitted with high efficiency particulate air (HEPA) units attached to open windows to create a negative pressure environment. Between June and December 2021, ten patients admitted to the medical intensive care unit (ICU) for treatment of COVID-19 infection acquired CAPA more than six days into their admission. This prompted an investigation into environmental sources of mold.

Methods: Infection Prevention completed an investigation of mold infections with unit leaders, environmental services, and facilities. Maintenance logs were reviewed and a unit walkthrough was performed. A deep clean of the unit was implemented. A plan to decommission retrofitted negative pressure rooms was developed.

Results: Average time from admission to mold infection was 14 days. All 10 cases had been in a retrofitted negative pressure room. An issue with the HEPA window seal was identified that increased the risk of outside air entering the room. High dust was observed outside of patient rooms. Complexities of performing an adequate unit clean in a high-activity ICU with a lot of equipment were identified. After implementing preventive measures including cleaning and decommissioning of retrofitted negative pressure rooms, no additional cases of hospital-associated mold infections were identified.

Conclusions: Special consideration to environmental cleaning should be given on high-activity ICUs with retrofitted negative pressure rooms. The risks and benefits of retrofitted negative pressure rooms should be considered before using this strategy for immunosuppressed patients in the future.

Learning Objectives:

Understand the risk for mold infection associated with retrofitted negative pressure environments.
List strategies for mitigation of mold found in the healthcare environment.
Understand patient and environmental risk factors for developing CAPA in critically ill patients.