Review - Reviewer's Assessment

1. Short summary / abstract
This documents aim is to act as guidance for healthcare staff to ensure that construction and renovation activities in hospitals are undertaken in a safe and appropriate manner so that the risk to patients who are vulnerable to invasive Aspergillosis is reduced as far as possible.
The guidelines are mainly consensus based with evidence used where available and include feedback from a wide consultation exercise in April 2001.
The guidelines include information on: -
Construction associated Nosocomial invasive Aspergillosis with a literature review of of outbreaks in hospitals
Classification of at-risk patients and risk factors
Preventive measures to control Aspergillosis including construction and ventilation measures, infection control measures, chemoprophylaxis and diagnosis and surveillance.
Organisation duties and responsibilities
National reference laboratory facilities
Appendices include sample construction permit, information leaflet on Aspergillosis during construction, recommended method for sampling of aspergillus species spores and notes on preparation of requirements for protection against invasive Aspergillosis
The protection of vulnerable patients will depend on effective infection control and engineering measures


2. What question is the document addressing?
The document includes the guidance necessary for healthcare staff to ensure that construction and renovation activities in hospitals are undertaken in a safe and appropriate manner so that the risk to patients who are vulnerable to invasive Aspergillosis is reduced as far as possible.

3. Type of study
Review and best practice guidance

4. Methods valid & appropriate?
Yes

Comments:
outbreaks of invasive Aspergillosis have become a well recognised complication of construction, demolition or renovation activities in or near healthcare establishments housing immune-compromised patients.

5. Results / recommendations reliable?
Yes: recommendations based on a literature review of previous construction related aspergillus outbreaks in hospitals

6. Any major problems and biases?
No

7. Any other important / relevant studies which confirm or contradict?
1. Working Party of the British Society for Antimicrobial Chemotherapy. Chemoprophylaxis for candidosis and Aspergillosis in neutropenia and transplantation: a review and recommendations Journal Antimicrobial Chemotherapy 1993; 32: 6-21
2. NHS Estates. Health Facilities Note (HFN) 30 – Infection Control in the Built Environment: design and planning (KIP) http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/EstatesAndFacilitiesManagement/EstatesAndFacilitiesArticle/fs/en?CONTENT_ID=4118956&chk=gz0VFG
3. Centres for Disease Control and Prevention (CDC), Healthcare Infection Control Practices Advisory Committee (HICPAC) (2001) Draft guideline for environmental infection control in healthcare facilities http://www.cdc.gov/ncidod/hip/enviro/guide.htm
4. Trends in Antimicrobial Resistance in England and Wales (December 2005) http://www.hpa.org.uk/infections/topics_az/antimicrobial_resistance/AMR_Rep_2001_03.pdf


8. Keywords
Invasive Aspergillosis construction renovation environment



Reviewer's Details:

Name:Sue Wiseman
Post:Nurse Consultant –Infection Control, DH
Affiliations
(Society / Organisation / Advisory Committee):
Member Advisory Committee on Dangerous Pathogens
Health Protection Adviser Royal College of Nursing P/T
Member Infection Control Nurses Association


*** Note: These are the views of a professional expert rather than an official statement from his or her society, organisation or advisory committee.






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