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INFECTION CONTROL IN HSCT: USE OF HEPA-FILTER BY Iyoha Osaretin

INFECTION CONTROL IN HSCT: USE OF HEPA-FILTER BY Iyoha Osaretin DEPARTMENT OF MEDICAL MICROBIOLOGY UNIVERSITY OF BENIN TEACHING HOSPITAL BENIN CITY. Haemopoeitic Stem Cell Transplantation (HSCT) HSCT - infusion of hematopoietic stem cells from a donor into a patient ( recipient)

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INFECTION CONTROL IN HSCT: USE OF HEPA-FILTER BY Iyoha Osaretin

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  1. INFECTION CONTROL IN HSCT: USE OF HEPA-FILTER BY IyohaOsaretin DEPARTMENT OF MEDICAL MICROBIOLOGY UNIVERSITY OF BENIN TEACHING HOSPITAL BENIN CITY

  2. Haemopoeitic Stem Cell Transplantation (HSCT) • HSCT - infusion of hematopoietic stem cells from a donor • into a patient ( recipient) • who has received chemotherapy • which is usually marrow ablative. • It has been used increasingly to treat: neoplastic diseases, hematologic disorders, immunodeficiency syndromes, congenital enzyme deficiencies autoimmune disorders.

  3. Classification based on the source of the transplanted haemopoeitic progenitor cells • allogeneic or syngeneic • autologous.

  4. Phase I <30 days neutropenia breeched barrier Candida spp, Aspergillus reactivated Herpes simplex virus • PHASE II <100 days CMI GVHD/Tx Herpes simplex cause pneumonia, hepatitis and colitis with potential opportunistic super infection. Pneumocystis jiroveci and Aspergillus spp. • Phase III CMI Humoral immunity RES CMV, Varicella zoster, EBV encapsulated bacteria

  5. Infections Fig.1: Bacterial infection in late post HSCT

  6. Level of CD4+/mm3 and common pathogens • 400 • 200 • 100 • 50 Bowden et al., 1995

  7. Other organisms that can reactivate CDC, 2000

  8. Sources of infection in HSCT • Host factors (endogenous). • Reactivation of viruses (HSV, VZV, CMV) • Barrier disruption causing massive disease(mucositis, IV catheters) • Colonization with resistant flora (G-ve bacteria, Vancomycin-resistantEnterococcus (VRE), yeast) • Reactivation of parasites (Toxoplasma, Strongyloides) • Environmental factors (exogenous). • Importance of positive pressure ventilation (Aspergillus spores) • Opportunistic pathogens (Legionella, Pneumocystis jiroveci, Listeria

  9. Organ transplant (blood production) • viral (CMV, HBV, HCV, HIV, HHV-6, HHV-7, Parvovirus, HTLV-) • Bacterial (organ contamination, TB) • Unknown (varrianCreutzfeldt – Jakob disease (vCJD), pig retroviruses) Management • Prevention is preferable to treating infection in HSCT. • Regular Hand Wash by attendant • Gut decontamination • Early Treatment of infection

  10. Pre-transplantation screening Pre-transplantation screening of the donor, recipient and / or blood products • Recipient Screening. • Ongoing or active infection • Ecological testing for HBV, HCV, HIV, HSV, VZV, EBV, CMV, T. pallidum, T. gondii • In endemic areas, T. Cruzi, Histoplasma, Strongyloides • Donor Screening. • Serological testing for HBV, HCV, HIV, T. pallidum, T. gondii • Culture of cadaveric organs, perfusates, transplant medium • Clinical and epidermiological history, Tuberculin testing and fungal serology. • Screening for malaria, T. Cruzi, etc. • Blood products. Screening for HBV, HCV, HIV, T. pallidum. Leukocyte depleted blood reduces the risk of CMV

  11. Post-transplantation surveillance • To guide pre-emptive therapy and monitor response to treatment. • CMV disease by PCR • Candida or infection by antigen tests. • Surveillance cultures for multi-drug resistant pathogens

  12. Prevention of infection • Routine immunization e.g. pneumococcal, influenza • Prophylactic antimicrobials first few months following transplantation, e.g. • Co-trimoxazole, • antivirals (acroclovir, Volaciclovir, ganciclovir or valganciclovir), • antifungal (nystatin, fluconazole, or triconazole). Protocols differ between different transplant centres.

  13. HEPA- filter: • Highly efficient particle air filter • Developed during word war 11 • Eliminates foreign particles • Filters > 0.3 microns 99.97% • Use in labs, kitchen, surgical facilities, ICU, etc.

  14. AIR FLOW USING MOTOR/FAN NOISELESS BUT ADJUSTABLE PURIFIER INCLUDING BACTERIA AND VIRUSES IF UV IS INC. FILTER REPLACEMENT-YEARLY

  15. GENERATES NEGATIVE IONS THAT ATTRACTS PARTICLES BECOMES TOO HEAVY AND FALLS TO THE GROUND

  16. USES PHOTOCATALYTIC OXIDATION TECHNOLOGY PROVEN EFFECTIVE AGAINST MRSA, OTHER BACTERIA, MOLDS ETC.

  17. Conclusion • The immunocompromised host - severe life threatening infections. • HSCT- immunocompromised state • The outcome in these patients can be improved by; prevention, including use of HEPA filter, prompt and extensive investigations , aggressive treatment.

  18. Thanks for listening!

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