Airborne fungal spores and invasive aspergillosis in hematologic units in a tertiary hospital during construction: a prospective cohort study

Abstract

Background Invasive aspergillosis (IA) is an opportunistic fungal infection that mostly occurs in immunocompromised patients, such as those having hematologic malignancy or receiving hematopoietic stem cell transplantation. Inhalation of Aspergillus spores is the main transmission route of IA in immunocompromised patients. Construction work in hospitals is a risk factor for environmental fungal contamination. We measured airborne fungal contamination and the incidence of IA among immunocompromised patients, and evaluated their correlation with different types of construction works. Methods Our tertiary hospital in Seoul, Korea underwent facility construction from September 2017 to February 2018. We divided the entire construction period into period 1 (heavier works: demolition and excavation) and period 2 (lighter works: framing, interior designing, plumbing, and finishing). We conducted monthly air sampling for environmental spore surveillance in three hematologic wards. We evaluated the incidence of IA among all immunocompromised patients hospitalized in the three hematologic wards (2 adult wards and 1 pediatric ward) during this period. IA was categorized into proven, probable, and possible aspergillosis based on the revised European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) criteria. Results A total of 15 patients was diagnosed with proven (1 case), probable (8 cases), or possible (6 cases) hospital-acquired IA during period 1. In period 2, 14 patients were diagnosed with either proven (1 case), probable (10 cases), or possible (3 cases) hospital-acquired IA. Total mold and Aspergillus spp. spore levels in the air tended to be higher in period 1 ( p = 0.06 and 0.48, respectively). The incidence rate of all IA by the EORTC/MSG criteria was significantly higher in period 1 than in period 2 (1.891 vs. 0.930 per 1000 person-days, p = 0.05). Conclusions Airborne fungal spore levels tended to be higher during the period with heavier construction works involving demolition and excavation, during which the incidence of IA was significantly higher as well. We recommend monitoring airborne fungal spore levels during construction periods in hospitals with immunocompromised patients. Subsequently, the effect of airborne fungal spore level monitoring in reducing hospital-acquired IA should be evaluated. Electronic supplementary material The online version of this article (10.1186/s13756-019-0543-1) contains supplementary material, which is available to authorized users.

Trends on Aspergillus Epidemiology—Perspectives from a National Reference Laboratory Surveillance Program

“…Our results showed an even higher frequency of cryptic species in environmental isolates, as corroborated by Simpson index value. As already shown in several studies [ 48 , 49 , 50 , 51 ], the environment represents the major source of Aspergillus isolates causing infections. Exposure to Aspergillus may occur at home, in agricultural/animal production, at the workplace, and during periods of hospitalization, among others.…”

Mold and Yeast-Like Fungi in the Seaside Air of the Gulf of Gdańsk (Southern Baltic) after an Emergency Disposal of Raw Sewage

“…Therefore, the outcomes of 2018 were compared to the quality of air at the sewage treatment plant in order to indicate the likely origin of the species. Filamentous fungi of the genus Aspergillus , Cladosporium, and Mucor and yeast-like fungi, for example, Candida, were detected in domestic human and animal sewage [ 35 , 36 , 37 , 38 ]. Michałkiewicz et al found that the majority of yeast-like fungi isolated from the air of the four wastewater treatment plants was Candida [ 39 ].…”

Hygienic Perspectives of Wood in Healthcare Buildings

“…Therefore, they are not cleaned as often as the frequent contact surfaces [33]. However, they may sustain the microbes and can result in transmission by accidental contact, or by indoor air contamination during cleaning, construction, and renovation operations [34,35]. Such air contamination is less likely, and if it happens, can cause respiratory and surgical site wound infections in susceptible patients [27].…”