Aspergillosis Infections Related to Hospital Construction

HOSPITAL CONSTRUCTION INCREASES ASPERGILLOSIS RISKS. Hospital construction, demolition, and renovation have often been associated with significant increases in hospital invasive aspergillosis infections (1).  Aspergillus is present in many areas including soil and building materials and there small spores (2.5-5.5 µm in diameter) can become easily airborne. (1)  Construction/ demolition related Aspergillosis infections are all too common, with one literature review reporting 53 outbreaks affecting 458 patients with a fatality rate of 58% (2). Traditionally, it has assumed that most Aspergillosis occurs in patients with HIV, blood cancers, or those on immunosuppressive therapy for cancer or autoimmunity (1).  However, recent reports also suggest that invasive hospital acquired infections can also occur in “non-immunocompromised patients such as those with severe influenza, chronic obstructive pulmonary disease (COPD), burns, cystic fibrosis, and neonates (3).

HEPA FILTERS, LAMINAR AIR FLOW AND ENVIRONMENTAL CLEANING REDUCE RISK OF HOSPITAL ASPERGILLOSIS INFECTIONS.  A number of studies have suggested that the use of HEPA air filters, positive pressure rooms and careful environmental cleaning is associated with significantly lower hospital Aspergillus infection rates (4).  One review reported that HEPA use in hospital rooms significantly reduced airborne levels of Aspergillusand/or rates of invasive aspergillus infections in 10 out of 13 (77%) of studies (5).

RECOMMENDATIONS TO REDUCE CONSTRUCTION RELATED ASPERGILLUS RISKS.  Recently, the Irish Aspergillus Subcommittee of the Health Protection Surveillance System published guidelines for reducing Aspergillus hospital infection risks (1).  The Guidelines suggest: 1) Assess Aspergillus Risk in Patient Population, 2) Perform Microbiological Air Sampling, 3) Provide Patients Anti-Fungal Drug Prophylaxis, 4) Maintain Ventilation Systems. 5) Education and Communication, 6) Use of HEPA Air Filters and HEPA air vacuums, 6) Dust Control, 7) Positive Air Pressure Rooms, 8) Screens, and 9) Surveillance of nosocomial Aspergillosis(1).

Related Article:

Mixed Influenza and Aspergillus Infections

REFERENCES

1. Talento AF, Fitzgerald M, Redington B, O’Sullivan N, Fenelon L, Rogers TR. Prevention of healthcare-associated invasive aspergillosis during hospital construction/renovation works. J Hosp Infect. 2019;103(1):1-12.
2. Vonberg RP, Gastmeier P. Nosocomial aspergillosis in outbreak settings. J Hosp Infect. 2006;63(3):246-54.
3. Stevens DA, Melikian GL. Aspergillosis in the ‘nonimmunocompromised’ host. Immunological investigations. 2011;40(7-8):751-66.
4. Combariza JF, Toro LF, Orozco JJ, Arango M. Cost-effectiveness analysis of interventions for prevention of invasive aspergillosis among leukemia patients during hospital construction activities. European journal of haematology. 2018;100(2):140-6.
5. Menegueti MG, Ferreira LR, Silva MF, Silva AS, Bellissimo-Rodrigues F. Assessment of microbiological air quality in hemato-oncology units and its relationship with the occurrence of invasive fungal infections: an integrative review. Revista da Sociedade Brasileira de Medicina Tropical. 2013;46(4):391-6.