Information for staff regarding construction and redevelopment

Infection risks associated with construction and redevelopment

Many types of fungi and bacteria can be disturbed during demolition and construction in healthcare facilities. This increases the risk that immune compromised patients will develop invasive infections such as Aspergillosis.

Patient risk

Most people are exposed to fungus such as Aspergillus at some time during their lives, but never develop an infection. Aspergillus spores are often present in the air and carried on wind currents from environmental sources. Healthy people usually inhale these spores without becoming sick. However, for patients who are immunocompromised, increased concentrations of Aspergillus spores in the air because of construction works may lead to severe invasive fungal infection. Such infections pose an increased risk of mortality for these patients.

Patients at highest risk are:

• neonates and infants,
• receiving immunosuppressive or cytotoxic therapy,
• transplant recipients,
• HIV infection, and
• those with granulomatous disease.

The incubation period can be a few days to months. Common clinical presentations include pneumonia, sinusitis, or invasive aspergillosis or other invasive fungal infection. Aspergillus is not spread person to person.

Preventing infection risks with construction and redevelopment

While all steps will be taken to reduce environmental risks posed by construction activities, dust may still be generated during this work. Please report any concerns you identify with dust to your line manager and the Infection Prevention and Control team.

Staff should never enter construction zones unless authorised.

Refer to Table 1 for information regarding individual risk factors to consider. All patients in categories 2-4 should wear a surgical mask when travelling in or out of the facility through any external zone impacted by construction.

Additionally, patients at increased risk of invasive fungal infections as per Table 1 (Category 2-4), where practicable, may need to be moved to an area well away from the works. Patients at the highest risk (Category 4), may need to be placed into a HEPA filtered positive pressure room or unit.

A high index of suspicion for the diagnosis of fungal infections such as Aspergillosis should be maintained for those persons identified as being at risk (Category 2-4) and ongoing surveillance through clinical and microbiological/histological specimen.