Aspergillus Outbreak at RPA Hospital: Two Dead Amid Construction Link

A cluster of Aspergillus fungal infections at Sydney's Royal Prince Alfred (RPA) Hospital's transplant unit between October and December of last year resulted in the deaths of two patients and serious illness in four others, who have since recovered. The Sydney Local Health District (SLHD) launched an investigation, identifying potential links to ongoing construction for the hospital's $940 million redevelopment.

The incident prompted a series of remedial actions and a subsequent public discussion regarding the timing of disclosure by NSW Health officials.

Six patients in RPA Hospital's transplant unit developed Aspergillus infections, with two fatalities and four serious illnesses, between October and December.

Outbreak Details and Patient Impact

Six patients in RPA Hospital's transplant unit developed Aspergillus infections between October and December of last year. Two patients died on November 5 and November 19, respectively, while the remaining four recovered.

Aspergillus is a common type of mold found in soil, dust, plants, and damp environments. While generally harmless to the public, it poses a significant health risk to immunocompromised individuals, such as organ transplant recipients who are often on immunosuppressant medication. Symptoms can include breathlessness, coughing up blood, and respiratory failure.

Typically, RPA Hospital recorded an average of one Aspergillus infection per year among transplant patients for the seven years prior to 2023, making the cluster of six cases within an eight-week period highly unusual. Another Aspergillus case was reported in May of the same year.

Potential Contributing Factors

The fungal outbreak is potentially linked to the hospital's ongoing $940 million redevelopment project, which commenced in 2023. The transplant unit is located adjacent to the construction site, and it is believed that construction activities may have stirred up mold spores.

A contractor's review also identified visible mold across four hospital floors and Aspergillus in a plant room on level four, with potential links to heavy rain and water damage. NSW Chief Health Officer Dr. Kerry Chant acknowledged construction as a known risk factor in hospital environments.

Hospital and Health District Response

RPA staff raised concerns about the cluster in December, following the six infections within an eight-week period. The NSW Health Minister's office was notified on December 24, leading to the formation of an expert panel led by Dr. Kerry Chant.

Immediate actions taken by the hospital and SLHD included:

Relocation of potentially at-risk transplant patients in December.
Closure of the transplant unit on January 2.
Installation of additional air filters.
Administration of antifungal medication to patients.
A deep clean of the transplant ward.
Review of air intake points.
Upgrades to air filtration systems.
Comprehensive air quality testing, which initially identified elevated Aspergillus levels in the transplant ward compared to other areas.
Ceiling resealing.
Pausing of construction works adjacent to the unit.

Following these measures and subsequent testing that indicated Aspergillus levels were no longer at harmful concentrations, the expert advisory panel approved the reopening of the ward on February 9. A review of the cluster is currently underway, and new advice on managing infections among transplant patients is expected to be issued.

Disclosure and Public Information

The outbreak was publicly disclosed on a Wednesday following parliamentary orders mandating the release of relevant documents. This led to criticism from the opposition, which accused the government of a "cover-up" due to the delayed public revelation.

"NSW Health prioritized directly informing affected patients, their families, visitors, and staff to avoid unnecessarily scaring people." — NSW Health Minister Ryan Park

NSW Health Minister Ryan Park denied claims of a cover-up, stating that NSW Health prioritized directly informing affected patients, their families, visitors, and staff to avoid "unnecessarily scaring people." He noted that "hundreds of people" were informed. The expert panel, led by Dr. Chant, advised this targeted communication approach over a general public announcement.

Minutes from a January meeting reportedly indicated hospital staff expressed concern about informing patients, and health district officials noted communication difficulties as the cause of infections had not yet been confirmed. NSW Health briefings acknowledged that a public statement would likely attract media attention. Shadow Minister for Health Sarah Mitchell criticized the timing, stating that information should have been disclosed earlier.

Broader Context

Minister Park acknowledged that mold regularly occurs in NSW Health buildings, particularly after periods of heavy rain, and stated that efforts are made to rectify and remove it promptly.

Dr. Chant also noted that air monitoring had not been routinely used, citing a gap in existing guidelines. Another transplant patient's death due to a fungal infection was determined by a doctor to be unrelated to this specific outbreak cluster.