[Table of Contents]

Volume: 27S2 • July 2001

Construction-related Nosocomial Infections in Patients in Health Care Facilities
Decreasing the Risk of Aspergillus, Legionella and Other Infections

Introduction and Rationale

Health care facilities are undergoing construction and renovations to address restructuring in the health care system. If dust particles contaminated with bacteria and fungi are dispersed during construction, there may be health risks for patients, staff, and visitors⁽¹⁾. Early planning in construction and renovation projects must integrate infection prevention and control, engineering services, and building design to prevent nosocomial (hospital-acquired) infections, and minimize allergen load and other workplace hazards^(1,2).

Several reports document incidents of construction-related nosocomial infections caused by Aspergillus species (spp)^(3-29) and Legionella spp^(30-34). Nosocomial aspergillosis is a cause of severe illness and mortality in immunocompromised patients^(8,19,35). The primary route of acquiring Aspergillus infection is by inhalation of fungal spores. Pneumonia results from local lung tissue invasion. The fungus may disseminate via the bloodstream to involve multiple other deep organs⁽³⁶⁾. The mortality rate is high for both nosocomial aspergillosis (65%-100%)^(24,37-43) and legionnaires' disease (24%-80%)^(41,44-46) in hospitalized populations, even when infections are recognized and treated.

Section A.3 discusses the risk factors for acquisition and death from nosocomial construction-related infections. Construction and renovation projects in health care facilities pose a threat to patients and may, occasionally, also be a health risk to staff and visitors.

As nosocomial aspergillosis is difficult to diagnose and treat⁽⁴⁷⁾, emphasis must be placed on prevention and surveillance to improve detection^(48,49). Legionnaires' disease is one of the few preventable nosocomial pneumonias, and so vigilant surveillance is recommended to identify nosocomial, laboratory-confirmed cases of legionellosis, taking into account the type of patient population served by the facility^(36,50). Appropriate infection prevention and control measures must be employed throughout construction and renovation projects in health care facilities to reduce health risks^(1,13,16,51). A multidisciplinary team of architects, engineers, infection prevention and control professionals (ICPs), and representatives from environmental services, administration, medicine, and nursing is necessary for appropriate risk management planning for construction projects^{(1,2,13,16,19,25,47,52-58)}. As an integral part of prevention, clear lines of communication among all personnel involved must be established in the planning phase of the project, and guidelines should be developed and followed to ensure that an effective communication plan is used throughout the project^(52,59,60). The protection of susceptible patients and residents will depend on the acceptance and effectiveness of implementing infection prevention measures. Successful risk management will require a high level of commitment, understanding and cooperation from all personnel involved in the construction or renovation project (G. Granek, P. Eng., Toronto: personal communication, 1998).

Currently, Canadian guidelines to address construction-related nosocomial infections and preventive measures to protect patients, health care facility staff, and visitors at the time of construction and renovation do not exist. This paper summarizes the evidence for construction-related nosocomial infections in the literature and identifies measures necessary to prevent disease transmission. The focus is on architects, engineers, infection prevention and control professionals (ICPs), and administrators who are involved in any aspect of health care facility construction and renovation. For the purposes of this document, construction and renovation activities refer to major and minor building activities that occur in established health care facilities but not to new, freestanding health care facilities being built.

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