Hospital construction and Aspergillus cases: a 2012–2025 retrospective analysis
C Raba-Parodi, M J Garcia-Quesada, L Castella-Fabregas, J H Wang-Wang, A Llop-Alguero, J Valera-Paloma, E Marin-Caba, S Espino-Laborde, E D Perez-Riveros, I Casas-GarciaAbstract
Background
Hospital construction and renovation activities are recognized risk factors for Aspergillus exposure and invasive aspergillosis. Continuous surveillance is essential, yet real-time indicators of such activities are often lacking. This study describes the epidemiology of Aspergillus cases and explores their temporal relationship with hospital works.
Methods
We performed a retrospective analysis of positive Aspergillus microbiological tests (PCR and galactomannan) in a tertiary university hospital in Catalonia from 2012 to 2025. Cases were classified as colonization, probable, or proven. Construction data (start/end dates, classification, location) were available only for 2025, when systematic recording began. Works were classified (I–IV) according to Catalan biosafety guidelines based on dust generation and patient risk, with class IV representing the highest-risk category.
Results
From 2012 to 2025, Aspergillus cases varied widely, from 14 in 2013 (1 proven, 11 probable, 2 colonizations) to 1 in 2019 (1 probable). In 2025, 181 construction activities were recorded: 3 (1.7%) class II, 107 (59.1%) class III, and 71 (39.2%) class IV. Most occurred in hospitalization areas (8, 44.2%), followed by controlled environments (38, 21.0%), common areas (27, 14.9%), critical care (25, 13.8%), and other relevant areas (11, 6.1%). In 2025, 10 cases were identified (2 colonizations, 6 probable, 2 proven), 8 (80.0%) of which were nosocomial, mainly in critical care and hospitalization wards. Three of the ten cases died. Two ICU cases temporally overlapped with construction works in the same area.
Conclusions
Hospital works may contribute to nosocomial Aspergillus infections. The increasing volume and complexity of activities highlight the need for real-time surveillance systems integrating construction indicators and clinical data. Strengthening environmental monitoring and infection control is essential to reduce risk.
Key messages
• Hospital construction activities may increase the risk of nosocomial Aspergillus infections, highlighting the need for continuous surveillance in high-risk healthcare settings.
• Real-time indicators of construction activity are essential to detect risk periods early and strengthen infection prevention strategies in hospitals.