New guidance warns of aspergillosis risk

The recently-finalised document published by the Health Protection Surveillance Centre (HPSC) has noted that, in some cases, there are “major building projects occurring on existing hospital campuses where the population of immunocompromised patients is significant”. The guidelines are an updated document that was first issued in 2002.

Prof Tom Rogers, Chair of the Aspergillosis Subcommittee, stated in his forward that there have been important changes in practice in relation to isolation facilities, antifungal therapies and fungal diagnostics, as well as the emergence of A.fumigatus strains with triazole resistance.

The guidelines underline that hospital management must give sufficient notice to all interested parties including the infection prevention and control team of any planned activities before they start so that a risk assessment and preventive measures can be put in place to protect vulnerable patients. Moreover, contractors must agree to and sign a construction permit and be compliant with the local infection prevention and control policy. High-efficiency particulate air (HEPA)- filtered positive pressure facilities are pre- ferred for the protection of high- and very high-risk patients during major internal and non-containable external activities, according to the document. In consultation with the clinical teams involved, consideration should also be given to prescribing antifungal drug prophylaxis in selected patients based on a risk assessment.

Nosocomial outbreaks of aspergillosis have become a well-recognised complication of construction, demolition or renovation work in or near hospital wards in which immunosuppressed patients are cared for.

Haematopoietic stem cell transplant (HSCT) recipients are the population at highest risk of invasive aspergillosis (IA). Other immunosuppressive conditions have frequently been reported as risk factors for construction-related nosocomial fungal infections: graft–versus-host disease requiring treatment, prolonged neutropaenia following cytotoxic chemotherapy, prolonged use of antibiotics, steroid therapy, and tumour necrosis factor α antagonists.

“As the complexity of therapeutics increases and the survival rates from oncologic and haematologic conditions improves, it is likely that more patients will be at risk of IA,” it states.