title: Refurbishment works in a hospital during normal operation.
abstract: BACKGROUND
  Construction and renovation work in hospitals pose risks of fungal airborne infections for immunosuppressed patients. If possible, reconstruction work will be postponed to periods without patient treatment. However, in many situations urgent damage demands immediate refurbishment works before the transferring of patients to other wards or closure of wards is possible. Reported here are infection control related measures and implemented procedures after two incidents of water damage which occurred on a surgical ward and an intensive care unit at the University hospital of Essen.
  
  
  METHODS
  Between January and April 2009 and between September and October 2009, respectively, concentration of air-borne particles and number of viable fungi were measured at two surgical wards and one ICU. Preventive Infection Control Measures included erection of protective walls and HEPA filtration of air from the renovation area.
  
  
  RESULTS
  During the renovation work on the surgical ward concentrations of moulds and particles ≥5 µm were significantly higher on the left side of the renovation area than on the right side (p=0.036 and p<0.001). Concentrations of particles ≥1 µm and particles ≥5 µm on both sides of the renovation area were significantly increased when compared with the control ward on the same floor but not when compared with the control ward on the other floor. Particles of all size were significantly elevated on the ICU during the renovation work. Aspergillus fumigatus could neither be cultured of the air of cardiac surgery intensive care unit nor of the intermediate care unit (control ward). During renovation works there was no nosocomial mould infection of patients treated on the two wards.
  
  
  CONCLUSIONS
  Provided that the renovation area is tightly insulated from the areas of patient care on a ward, closure does not seem to be necessary during renovation works because variation of airborne fungi is similar to that of outdoor or control air. However a multidisciplinary team should be established. This team should perform risk assessment and determine necessary protective measures before starting any construction, renovation or maintenance work in health care settings.
authors.affiliation: Krankenhaushygiene, Universitätsklinikum Essen, Essen, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Ross
authors.forename: Dorothea
authors.initials: D
authors.lastname: Hansen
authors.forename: Tim
authors.initials: T
authors.lastname: Lieske
authors.forename: Joschka
authors.initials: J
authors.lastname: Krude
authors.forename: Fuat
authors.initials: F
authors.lastname: Saner
authors.forename: Günter
authors.initials: G
authors.lastname: Marggraf
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Heinz G
authors.initials: HG
authors.lastname: Jakob
authors.forename: Walter
authors.initials: W
authors.lastname: Popp