Fungi in the indoor air of critical hospital areas: a review.

Invasive fungal infection is an important cause of mortality and morbidity in neonates, especially in low-birthweight neonates. The contribution of fungi in the indoor air to the incidence of mucocutaneous colonization and to the risk of invasive fungal infection in this population is uncertain. This review aimed to identify and to summarize the best available evidence on the fungal contamination in the indoor air of critical hospital areas with an emphasis on pediatric/neonatal ICUs. Publications from 2005 to 2019 were searched in the databases Scientific Electronic Library Online (SciELO), US National Library of Medicine National Institutes of Health Search (PubMed), and Latin American Caribbean Health Sciences (LILACS). Descriptors in Health Sciences (DeCS) were used. Research papers published in Portuguese, English, and Spanish were included. Twenty-nine papers on all continents except Australia were selected. The results showed that the air mycobiota contained several fungal species, notably Aspergillus, Penicillium, Cladosporium, Fusarium, and yeast (Candida) species. The selected papers point out the risks that fungi pose to neonates, who have immature immune system, and describe simultaneous external factors (air humidity, seasonality, air and people flow, use of particulate filters, and health professionals' hand hygiene) that contribute to indoor air contamination with fungi. Improving communication among health professionals is a great concern because this can prevent major health complications in neonates, especially in low-birthweight neonates. The results reinforced the need to monitor environmental fungi more frequently and efficiently in hospitals, especially in neonatal ICUs.

Disinfectants in a Hemodialysis Setting: Antifungal Activity Against Aspergillus and Fusarium Planktonic and Biofilm Cells and the Effect of Commercial Peracetic Acid Residual in Mice.

Aspergillus and Fusarium cause a broad spectrum of infections in humans, mainly in immunocompromised patients. Among these, patients undergoing hemodialysis are highly susceptible to infections, requiring a constant and adequate environmental disinfection program. Nevertheless, monitoring the residual disinfectants can contribute to the morbidity and mortality reduction in these patients. Here, we evaluated the susceptibility of Aspergillus spp. (n=19) and Fusarium spp. (n=13) environmental isolates against disinfectants (acetic acid, citric acid, peracetic acid, sodium hypochlorite, and sodium metabisulphite) at different concentrations and time exposures. Also, we investigated the in vivo toxicity of the peracetic acid residual concentration in mice. Fusarium isolates were identified by F. equiseti, F. oxysporum and F. solani while Aspergillus presented clinically relevant species (A. fumigatus, A. niger and A. terreus) and environmental ones. Against planktonic cells, only two disinfectants (acetic acid and sodium hypochlorite) showed a fungicidal effect on Fusarium spp., while only one (sodium hypochlorite) was effective against Aspergillus spp. Both fungi formed robust in vitro biofilms with large amounts of the extracellular matrix, as evidenced by electron micrographs. Exposure of fungal biofilms to disinfectants showed sensitivity to three (acetic, citric, and peracetic acids), although the concentrations and times of exposure varied according to the fungal genus. Mice exposure to the residual dose of peracetic acid during 60 weeks showed anatomopathological, hematological, and biochemical changes. The implementation of news control measures and those that already exist can help reduce infections, the second cause of death and morbidity in these patients, besides providing safety and well-being to them, a priority of any quality health program.