Airborne Fungal Monitoring in Healthcare Environments: A Systematic Review

Area of Science:

• Environmental microbiology
• Public health
• Infection control

Background:

• Fungal infections cause millions of deaths annually, with indoor airborne spores posing a significant risk.
• Exposure occurs via inhalation or surface contact, necessitating effective monitoring for early detection and prevention.
• Routine airborne fungal testing is not universally mandated in healthcare settings, creating a critical gap in infection control.

Purpose of the Study:

• To systematically review current airborne fungal monitoring guidelines and best practices.
• To identify methods for sample collection, culture media, incubation, and interpretation of results.
• To assess the current state of fungal monitoring in healthcare environments.

Main Methods:

• A systematic review of peer-reviewed articles from four databases was performed.
• Inclusion criteria focused on airborne fungal monitoring guidelines and best practices.
• Eighteen articles were selected for analysis.

Main Results:

• Four studies proposed guidelines for acceptable airborne fungal levels, ranging from <1 CFU/m³ (HEPA-filtered) to >1000 CFU/m³ (non-filtered).
• Common airborne fungi included Aspergillus, Penicillium, Alternaria, Cladosporium, and Rhizopus, with six WHO-critical pathogens identified.
• Impaction sampling with specific agar media (Sabouraud dextrose/malt extract with chloramphenicol), 2-7 day incubation at 25-30°C, and morphological identification were common.

Conclusions:

• There is an urgent need for globally recognized standards for airborne fungal monitoring.
• Lack of standardized monitoring perpetuates preventable fungal exposure risks.
• Implementing consistent standards is vital to protect patients and healthcare workers from severe, potentially fatal fungal infections.