Is the quantitative cut-off a suitable surrogate to ensure a good indoor air quality regarding the mycobiota in health care facilities?

Projeto EXPOsE – Establishing protocols to assess occupational exposure to microbiota in clinical settings (02/SAICT/2016 – Project nº 23222).Studies have reported that there is a significant relationship between hospital infections and bioaerosols. Fungi are present in clinical indoor environments and play important roles in human diseases in patients and staff. Aspergillus is a common fungus in invasive infections, however, other fungi are enrolled as pathogens in immunosuppressed patients. The azole-resistant Aspergillus sp. has up to 30% prevalence in some European hospitals, which report higher than 90% mortality rates. Control measures are crucial in clinical environments for reducing concentrations of airborne fungal contamination and to avoid invasive infections acquired from indoor air. We cannot fully eliminate fungi from indoor clinical environments and enforcement is needed to ensure, at least, proper Indoor Air Quality (IAQ) assessments. Portuguese legislation established limit values for air bioburden in indoor environments in general, without any specific requirement for health care facilities. This study focuses on the mycobiota assessment in 10 Primary Health Care Centers (PHCC) applying the IAQ Portuguese legislation as guidance. After the quantitative cut-off analyses (I/O) the fungal species identification was performed to verify if the fungal conformity was achieved even in those that comply with the I/O ratio.