2025 GAHFM Technical Education Conference-2015-Review-of-Fungal-Outbreaks-and-Infection during construction

2015-Review-of-Fungal-Outbreaks-and-Infection during construction

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This review article examines fungal outbreaks linked to hospital construction and renovation over the past four decades, highlighting infection prevention strategies in healthcare settings. Construction and renovation activities generate dust and disperse fungal spores, notably Aspergillus species—the predominant pathogen causing pulmonary infections in immunocompromised patients, especially those with hematological malignancies and transplant recipients. Other fungi like Zygomycetes have also been implicated occasionally. Mortality associated with these fungal infections is high, averaging around 48–58%, varying by patient group and infection site. <br /><br />The authors analyzed 49 studies between 1974 and 2014, mostly from tertiary care and university hospitals, where advanced treatments create vulnerable populations. Outbreaks commonly involved airborne transmission of Aspergillus spores dispersed from construction sites via deficient barriers, ventilation systems, and dust contamination. Air sampling was used in many investigations, but standardized methods and correlating spore counts to infection risk remain unresolved challenges.<br /><br />Molecular typing was performed infrequently, and its epidemiologic value is limited due to the genetic diversity of environmental Aspergillus strains and multiple simultaneous fungal sources during outbreaks. Diagnostic challenges persist due to nonspecific clinical signs and limitations of existing microbiological and biomarker assays for invasive fungal infections.<br /><br />Infection prevention requires multidisciplinary coordination, including risk assessments prior to construction, stringent airborne spore control measures such as sealed barriers, HEPA filtration, patient relocation, environmental cleaning, and staff education. Guidelines from the CDC and other bodies emphasize infection control risk assessment (ICRA) to tailor prevention based on construction type and patient risk. Although antifungal prophylaxis is common in high-risk patients, its efficacy specifically during construction periods needs further study.<br /><br />Outbreak incidence appears to have declined recently, likely reflecting better prevention policies and prophylaxis. However, fungal infections linked to construction and renovation remain a significant healthcare threat, necessitating vigilant risk assessment, environmental controls, surveillance, and ongoing research to optimize detection, source identification, and preventive interventions.

Keywords

fungal outbreaks

hospital construction

infection prevention

Aspergillus

immunocompromised patients

pulmonary infections

airborne transmission

HEPA filtration

infection control risk assessment

antifungal prophylaxis