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Dealing with mold infestation in hospitals and medical practices
Julia Hurraß1,2, Eva-Brigitta Kruse-Wehner1,3, Steffen Engelhart4
1HYGIUM - Center for Hygiene and Environmental Medicine, Cologne, Germany.
Introduction:
Mold, which includes the components and metabolic products of mold fungi as well as other factors associated with moisture, such as yeasts, bacteria (actinobacteria) and mites, occurs indoors when there is increased moisture. In addition to known causes of damp/mold damage such as structural defects (including thermal bridges, rising damp, insufficient ventilation), water damage and incorrect ventilation and heating options, construction work plays an important role in hospitals and medical practices.
Methods:
The AWMF S2k guideline "Medical clinical diagnostics for indoor mold exposure" was first published in 2016. Following a new systematic literature search, an updated version of this guideline was published in October 2023 with the cooperation of various medical disciplines and other experts. The guideline is intended to close the existing knowledge gap in terms of rational and efficient medical diagnosis in cases of indoor mold contamination. Recommendations are given on general and specific examination methods. Non-evidence-based diagnostic methods, some of which are still used in practice, are not recommended. Furthermore, treatment options for health problems and diseases caused by mold fungi are presented. It is explained why, in most cases, indoor measurements of molds, their components or metabolites are not required for medical evaluation.
Results:
Individuals who are immunosuppressed (grade 2 and 3 of the immunosuppression grades according the Commission for Hospital Hygiene and Infection Prevention [KRINKO] at the Robert Koch Institute [RKI]), or are suffering from severe influenza, severe COVID-19, cystic fibrosis and uncontrolled bronchial asthma are at increased risk of exposure to mold fungi. For these patients, exposure to mold damage must be ruled out in the clinic and practice as well as in the home environment.
Conclusion:
If, despite all precautionary measures, moisture/mold damage can be detected in the environment of these particularly vulnerable patients, it must be remediated immediately. Indoor measurements of mold exposure are not indicated for medical reasons. Rather, all measures that help to avoid moisture damage are crucial for prevention.
Insights
Indoor mold exposure is a health risk, especially for immunocompromised individuals. Updated guidelines emphasize ruling out mold damage and immediate remediation, advising against routine indoor mold measurements for medical evaluation.
Area of Science:
- Environmental Health
- Medical Diagnostics
- Infectious Disease Epidemiology
Background:
- Indoor mold growth is linked to moisture, structural defects, water damage, and construction, particularly in healthcare settings.
- Factors associated with moisture, including yeasts, bacteria, and mites, contribute to indoor mold-related issues.
- Construction work can play a significant role in the occurrence of mold in hospitals and medical practices.
Purpose of the Study:
- To provide updated recommendations for rational and efficient medical diagnosis of indoor mold exposure.
- To address the knowledge gap in diagnosing mold-related health issues.
- To present evidence-based treatment options for mold-induced health problems.
Main Methods:
- Systematic literature search to update the 2016 AWMF S2k guideline on medical diagnostics for indoor mold exposure.
- Inclusion of various medical disciplines and experts in the guideline revision process.
- Focus on general and specific examination methods for diagnosing mold exposure.
Main Results:
- Individuals with severe immunosuppression, influenza, COVID-19, cystic fibrosis, or uncontrolled asthma are at higher risk from mold exposure.
- Exposure to mold damage must be ruled out for at-risk patients in clinical, practice, and home environments.
- Non-evidence-based diagnostic methods are not recommended.
Conclusions:
- Immediate remediation of detected moisture/mold damage is crucial for vulnerable patients.
- Indoor mold measurements are generally not indicated for medical evaluation.
- Preventive measures to avoid moisture damage are paramount for reducing health risks.
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