Demolition, Construction, and Aspergillus Risk: Seeing Stripes or a Tiger? A Critical Narrative Review and Perspective

Abstract

Environmental disturbances from hospital demolition and construction can aerosolise pathogenic fungal spores, particularly those of Aspergillus species, posing a serious threat to immunocompromised patients. This paper presents a structured narrative review of representative case studies to evaluate the relationship between demolition activities and airborne Aspergillus exposure, with a focus on clinical risk and environmental monitoring. Three exemplar studies were selected to illustrate high-intensity short-duration demolition, prolonged mechanical demolition, and meteorologically integrated risk assessment. By examining these cases, this review identifies gaps in current knowledge, methodological limitations, and challenges in causal attribution. The analysis supports the development of a novel conceptual framework for assessing and managing Aspergillus-related risks during hospital redevelopment, offering a structured approach to future infection prevention and control strategies. This framework is intended as a conceptual tool to support evidence-informed decision-making while acknowledging the limitations inherent in a targeted narrative review rather than a systematic synthesis.