[The epidemiological surveillance network for nosocomial invasive aspergillosis of the Assistance Publique-Hôpitaux de Paris].

Since January 1990, a epidemiology surveillance network has been set up by the Paris hospitals for nosocomial invasive aspergillosis. The network includes 39 high risk clinics (haematology, bone marrow graft, organ transplantation) in 19 hospitals. Over the first 3 years of surveillance (1990-1992), 132 cases of aspergillosis have been registered as probably invasive and nosocomial. The incidence of nosocomial invasive aspergillosis invasive aspergillosis has been estimated at 1.16 per 1,000 patient-days in haematology wards, at 4.56% in bone marrow graft and at 1.57 in liver transplantation. Mortality was 57% for all cases registered and 75% for bone marrow transplant patients; 97% of these patients were immunodepressed. Room air filtration with an absolute filter system had been installed for only 32% of the patients at diagnosis of invasive nosocomial aspergillosis. Work areas were in the environment of 68% of the cases reported. Surveillance led to the establishment of incidence and mortality data and emphasized the importance of the problem in terms of public health. In addition, three main elements were recognized concerning the disease: the number of immunodepressed patients in increasing in the hospitals, room air filtration equipment is inadequate, unavoidable work areas in hospitals have a significant effect. A practical guide for the prevention of invasive nosocomial aspergillosis in case of work areas in the hospital was published in 1993. Nevertheless, the proposed measures must be integrated into a global prevention strategy to eliminate sources of contamination and improve food facilities, architecture, air conditioning, internal organization and personnel training in high risk clinics.