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Brief report
Compilation of regulations and procedures for monitoring filamentous fungi in hospital environments
Recopilación de normativas y procedimientos para la monitorización de hongos filamentosos en ambientes hospitalarios
Iris L. Agorioa,b,
Corresponding author
irisagorio@gmail.com

Corresponding author.
, Norma B. Fernándezb,c, María Silvia Rellosob,d, Ivana Maldonadob,e
a Cátedra de Microbiología, Carrera de Medicina, Facultad de Ciencias Médicas, Pontificia Universidad Católica Argentina, C.A.B.A., Argentina
b Subcomisión de Micología Clínica. Asociación Argentina de Microbiología, Argentina
c Sección Micología, División Infectologia, Hospital de Clínicas “José de San Martin”, Universidad de Buenos Aires, Argentina
d CEMIC, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”, Argentina
e Microbiología, Laboratorio Central, Hospital Alemán, Argentina
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which is attributable to multiple causes&#44; such as construction works in the area of the facilities or its surroundings<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;10&#44;11&#44;13</span></a>&#46; The role of the clinical mycology laboratory in monitoring environmental fungi involves a complex and laborious practice that requires interdisciplinary work&#44; sample collection planning&#44; processing strategies&#44; and interpretation of results&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this report&#44; we describe the procedures used to assess the presence of FF in the environment of hospital areas considered to be at risk for the development of IFD&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The areas in the health centers are standardized into categories based on their clean air requirements&#44; which vary depending on the clinical characteristics of the patients and the activities performed&#46; These areas are designed based on an appropriate building structure&#44; specific equipment&#44; and ventilation systems that maintain controlled environmental parameters to achieve low levels of contamination&#46; The filtered air that flows into the environment should circulate from the clean areas &#40;higher safety areas for the patients&#41; to the unclean areas &#40;lower safety areas&#41;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To validate these rooms&#44; it is necessary to monitor the quality of the air circulating within them&#46; There are international standards that classify air quality&#59; however&#44; it is important to note that acceptable levels of airborne microorganisms may vary based on guidelines and regulations established by health authorities&#46; The International Organization for Standardization &#40;ISO&#41; standard validates the operability of clean rooms based on the count of airborne particles by their size in &#956;&#47;m<span class="elsevierStyleSup">3</span> of air&#44; known as ISO 14644-1&#44; which includes classes ranging from ISO 1 &#40;aseptic area&#41; to ISO 9 &#40;less clean air&#41;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&#46; The European Union regulations detailed in the Guide to Good Manufacturing Practice &#40;EU GMP&#41; classify clean rooms into grades A&#44; B&#44; C and D<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#44; depending on the level and size of particles&#47;m<span class="elsevierStyleSup">3</span> of air&#44; viable microorganisms&#47;m<span class="elsevierStyleSup">3</span> of air and the activity in the area&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows a comparison of the classification of clean areas according to both international standards&#46; The concordance between them is observed not only in terms of the maximum count of particles allowed but also in its relationship with the number of viable microorganisms&#47;m<span class="elsevierStyleSup">3</span> and the corresponding hospital area<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&#46; The maximum accepted level for particles and microorganisms is established for each type of room&#46; When these values are reached&#44; a follow-up alert is generated&#59; however&#44; if they are exceeded&#44; prompt corrective measures must be implemented<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">In Argentina&#44; the National Single Central Institute for Ablation and Implant Coordination &#40;INCUCAI&#44; as per its acronym in Spanish&#41;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#44;7</span></a> is the organism that regulates the processes that ensure the quality of good hospital practices and specifies the necessary infrastructure requirements for rooms used for cell and&#47;or tissue bank processing&#44; as well as rooms for patients undergoing autologous and allogeneic hematopoietic progenitor cell transplantation&#46; In addition&#44; INCUCAI outlines environmental microbiological control measures and their frequency in response to specific situations<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Areas for monitoring include&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#40;a&#41;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Rooms for immunocompromised patients undergoing bone marrow transplantation &#40;BMT&#41; with neutropenia &#40;&#8804;100<span class="elsevierStyleHsp" style=""></span>cells&#47;mm<span class="elsevierStyleSup">3</span>&#41; and an expected duration of &#8805;1 week&#46; These rooms are equipped with HEPA filters &#40;99&#46;97&#37; efficiency for particles of 0&#46;3<span class="elsevierStyleHsp" style=""></span>&#956;m&#41; with recirculation&#44; positive air pressure &#40;&#62;2&#46;5<span class="elsevierStyleHsp" style=""></span>Pa&#44; ideally &#62;8<span class="elsevierStyleHsp" style=""></span>Pa&#41;&#44; &#62;12<span class="elsevierStyleHsp" style=""></span>air changes&#47;hour&#44; and airflow direction from clean to unclean areas<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#46; In these rooms only FF is assessed&#46; Several air intakes are performed&#44; including below the laminar flow that filters air with high efficiency &#40;grade A&#47;ISO class 5&#41;&#44; at the patient&#39;s bedside headboard&#47;feet&#44; in corners adjacent to the laminar flow &#40;empty grade B&#47;ISO class 5&#41; at the air entrance and exit areas of the room&#46; In the bathroom &#40;grade C&#47;ISO class 7&#41; air intake procedures should be conducted both before and after using the shower&#44; leaving it open for at least 5<span class="elsevierStyleHsp" style=""></span>min&#46; The search for airborne FF is complemented with swabs of wet surfaces&#44; such as shower heads&#44; faucet spouts&#44; bathtub&#44; sink and bidet drains<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;12</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#40;b&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Tissue and cell banks &#40;TCB&#41; where materials are manipulated in accordance with air quality and cleanliness standards&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#40;c&#41;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Operating rooms equipped with high-efficiency HEPA air filter cabinets &#40;QHEPA&#41; where orthopedic or cardiovascular prosthetic implant surgeries are performed&#44; and material for the bone bank is fractionated<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#40;d&#41;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Hospital pharmacy sectors &#40;HOP&#41; where sterile solutions for high-risk medications &#40;dangerous drugs&#41; are prepared&#46;</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">In the cases of TCB&#44; QHEPA&#44; HOP&#44; the air within the high-efficiency cabinets in operation &#40;grade A&#47;ISO class 5&#41; and in the work area around the cabinets are evaluated&#44; considering the air flow circulation &#40;grade B empty&#47;ISO class 5&#41;&#46;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#40;e&#41;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Critical care units&#44; burn units and conventional operating rooms will be monitored in specific situations&#44; such as outbreak studies to identify an environmental source&#44; suspicion of surgical site infections&#44; modification of cleaning protocols&#44; building constructions&#44; remodeling and&#47;or repairs&#44; cleaning of ventilation ducts&#44; and before enabling operating theaters<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46;</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">In addition to FF&#44; mesophilic bacteria are assessed in TCB&#44; QHEPA&#44; HOP&#44; and conventional operating rooms&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">If during monitoring something out of the cleaning standard is observed&#44; the surfaces will be evaluated&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The procedures include&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Environmental sampling planning</span>&#46; The following must be considered to design and establish the sampling sites&#58; the ventilation flow &#40;air inlet and outlet direction&#41;&#44; the area where the patients are or will be located&#44; and the activity and circulation of staff&#46; A thorough and careful examination of the entire room must be conducted&#44; including walls&#44; windows&#44; inside closets&#44; and vertical surfaces hidden behind furniture&#44; in search of moisture stains or reservoirs that could harbor fungi&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Measurement of non-viable particles</span> is an important component of preventive maintenance as it is a measure of the degree of contamination of the site and is considered &#8220;real time&#8221; data&#46; This service is provided by companies specialized in environmental biosafety and is supervised by the hospital bioengineering sector&#46; A laser counter is used to indicate the total number of particles classified by size from 0&#46;3 to 10<span class="elsevierStyleHsp" style=""></span>&#956;&#47;m<span class="elsevierStyleSup">3</span> of air&#46; If the measurement exceeds the site&#39;s particulate standard&#44; immediate action must be taken to correct the deviation<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;9</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#40;3&#41;</span><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Measurement of viable particles</span>&#46; The transmission of airborne conidia depends on the dispersal characteristics of the fungus&#46; In the case of Eurotiales conidia&#44; such as <span class="elsevierStyleItalic">Aspergillus</span>&#44; which have hydrophobic behavior&#44; they are easily released&#44; dispersed and maintained by flotation in the air<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a>&#46; Hypocreales conidia &#40;e&#46;g&#46; <span class="elsevierStyleItalic">Fusarium</span> spp&#46;&#41;&#44; as they are viscous&#44; remain suspended in the air for less time and are distributed in the environment by adhering to objects or drops of humidity&#59; therefore&#44; their search must be complemented with surface swabs from humid places<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>&#46;</p></li></ul></p><p id="par0120" class="elsevierStylePara elsevierViewall">The measurement of viable particles can be done by either the sedimentation or gravimetric method &#40;passive&#41; or volumetric method &#40;active&#41;&#46;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#40;3a&#41;</span><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Gravimetric method</span>&#58; bioaerosols deposit by gravity&#44; depending on the size of the spores according to the Lewis&#8211;Stokes equation<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#46; Suspended particles in the air &#8805;5<span class="elsevierStyleHsp" style=""></span>&#956; are deposited&#44; while those &#8804;5<span class="elsevierStyleHsp" style=""></span>&#956; float due to their aerodynamic behavior&#46; For example&#44; conidia of <span class="elsevierStyleItalic">Aspergillus</span> section <span class="elsevierStyleItalic">Fumigati</span> have a small diameter&#44; ranging from 2 to 3<span class="elsevierStyleHsp" style=""></span>&#956;&#46; In addition to their hydrophobic characteristic&#44; they are rough on the external surface&#44; which increases their floating time and allow them to remain suspended in the air for prolonged periods&#46;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">-</span><p id="par0130" class="elsevierStylePara elsevierViewall">It is useful for monitoring inside a biological safety cabinet where filtered air is blown in a vertical laminar fashion at a constant velocity &#40;grade A&#47;ISO class 5&#41;&#46; In these cabinets&#44; uncovered 90<span class="elsevierStyleHsp" style=""></span>mm Petri dishes with appropriate culture media for the development of FF and mesophilic bacteria are used&#59; these are placed in 5 or 6 positions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; for a time ranging from 1<span class="elsevierStyleHsp" style=""></span>h to no more than 4<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">-</span><p id="par0135" class="elsevierStylePara elsevierViewall">This method is not recommended in larger sites such as rooms and operating theater suites &#40;grades B&#47;C&#47;D&#41; because it does not represent the real environmental fungal load<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#46;</p></li></ul></p></li></ul></p><p id="par0140" class="elsevierStylePara elsevierViewall">Accompanied by surface sampling&#44; either with swabs or touch plates&#44; the gravimetric method could be a transitional alternative in institutions that do not have access to the volumetric method&#46; However&#44; we emphasize that their results do not provide a real assessment of the aerial fungal biota&#46;<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#40;3b&#41;</span><p id="par0145" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">volumetric method</span> is performed using an air sampling equipment that works with a reverse ventilator that sucks and impels a specified air flow&#46; The most used flow rate is 100<span class="elsevierStyleHsp" style=""></span>l&#47;min &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall">Devices vary depending on the way the air impacts&#59; this impact can be perpendicular or tangential&#46; The most commonly used devices are those with perpendicular &#40;orthogonal&#41; impact&#46; In these systems&#44; the aspirated air passes through a perforated head with multiple holes that impact the surface of a plate containing a culture medium&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">There are several types of equipment&#44; each with different efficiency levels&#44; some equipped with a tripod and remote control&#46; When acquiring or renting this equipment&#44; it is important to consider that the head is adapted to contain 90<span class="elsevierStyleHsp" style=""></span>mm plates&#44; which is the standard size for Petri dishes&#46; If the equipment has two independent heads&#44; this will speed up the sampling process&#46; The heads are sterilized in an autoclave &#40;wet steam&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">These devices require annual calibration &#40;preventive maintenance&#41; to certify the volume of air aspirated per minute&#46; The sampling height for the equipment should be between 1&#46;2 and 1&#46;5<span class="elsevierStyleHsp" style=""></span>m from the floor&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The air volume to be sampled at each position ranges between 250&#44; 500&#44; and 1000<span class="elsevierStyleHsp" style=""></span>l&#44; depending on the estimated degree of contamination in the area to be sampled&#46; In all cases the planning should include a prior control sampling to assess the quality of the air and better define the sampling design in terms of the volume of air to be sampled&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In clean environments &#40;rooms grade C&#47;D&#44; ISO class 7&#47;8&#41;&#44; 250&#8211;500<span class="elsevierStyleHsp" style=""></span>l should be aspirated per position&#44; while in very clean or ultra clean environments &#40;rooms grade A&#47;B&#44; ISO class 5&#41;&#44; 500&#8211;1000<span class="elsevierStyleHsp" style=""></span>l should be aspirated per position&#46; It is not advisable to sample a larger volume per plate because it will dehydrate the culture medium used&#46; The total volume sampled per site should be representative of the total volume of that environment&#46; On average&#44; this would correspond to an average of 4000&#8211;6000<span class="elsevierStyleHsp" style=""></span>l &#40;40&#8211;50&#37; of the air in the site&#41;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#46;<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#40;4&#41;</span><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Surface sampling</span> is performed using a swab moistened in sterile saline solution&#46; This practice always applies when the sampling is carried out in BMT rooms for humid surfaces and&#47;or when irregular situations of cleanliness or humidity stains are observed in any of the abovementioned rooms&#46; The swabs are transported in properly labeled sterile tubes&#46; If cultivation for FF is not done immediately&#44; these tubes should be kept refrigerated until processed&#46;</p></li></ul></p><p id="par0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Culture media and temperature conditions</span>&#58; selective culture media such as Sabouraud agar or malt agar with added antibiotics are used&#46; In the latter&#44; colonies develop with a reduced diameter and adequate fructification&#44; allowing better visualization for counting and microscopic observation&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The optimum incubation temperature for the growth of most environmental FF is 28&#8211;30<span class="elsevierStyleHsp" style=""></span>&#176;C&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">To investigate the presence of thermotolerant species such as <span class="elsevierStyleItalic">Aspergillus</span> section <span class="elsevierStyleItalic">Fumigati</span>&#44; <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; or <span class="elsevierStyleItalic">Fusarium</span> spp&#46; it is advisable to incubate at 35&#8211;37<span class="elsevierStyleHsp" style=""></span>&#176;C&#59; therefore&#44; 2 intakes &#40;plates&#41; per position should be collected&#44; one for each temperature<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Outcome record</span>&#58; a preliminary report is conducted after 72<span class="elsevierStyleHsp" style=""></span>h of incubation&#44; and the final incubation time is 7 days&#46; The final report is prepared based on the methodology available for the identification of the isolates&#46; The results are expressed in colony forming units &#40;CFU&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In the gravimetric method&#44; the CFU count per plate exposure time is reported&#46; In the volumetric method&#44; the count is expressed in CFU&#47;m<span class="elsevierStyleSup">3</span> of air&#46; For surface sampling swabs indicate the absence or presence of FF with its identification&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">When the colony count is performed&#44; this number must be adjusted with a correction factor&#44; which varies depending on the efficiency of the sampler&#46; Each equipment has the corresponding conversion table in the instruction manual&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">After 72<span class="elsevierStyleHsp" style=""></span>h of incubation&#44; colony development should be carefully evaluated to prevent the spread of conidia&#46; If <span class="elsevierStyleItalic">Aspergillus</span> spp&#46;&#44; <span class="elsevierStyleItalic">Fusarium</span> spp&#46;&#44; <span class="elsevierStyleItalic">Scedosporium</span> spp&#46; and&#47;or Mucorales are suspected&#44; a preliminary identification should be conducted&#44; and the count reported immediately&#46; This information will allow prompt corrective decisions&#44; such as the verification of the state of the ventilation system&#44; infrastructure&#44; cleanliness&#44; area activity&#44; among others&#46; After 7 days of incubation&#44; the final count is performed&#46; Reports should include the area of origin&#44; the time of sampling&#44; and important considerations such as whether the sampling was taken when the area was empty or occupied&#44; whether the activity was normal or not&#44; whether it was done before or after daily cleaning&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">When the search for mesophilic bacteria is required&#44; it is advisable to use nutrient agar and the count will be carried out after 48<span class="elsevierStyleHsp" style=""></span>h&#44; indicating the number of CFU&#47;m<span class="elsevierStyleSup">3</span> of air and the identification of the colonies&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows criteria for the evaluation of results for their interpretation according to the air quality requirements of the site&#44; based on the EU GMP<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;5</span></a>&#44; on guidelines<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;13</span></a>&#44; and on published works from different experiences<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0240" class="elsevierStylePara elsevierViewall">The fungal load and the isolation of other FF such as <span class="elsevierStyleItalic">Penicillium</span> spp&#46;&#44; <span class="elsevierStyleItalic">Cladosporium</span> spp&#46; and others&#44; should be reported to the infection control team&#46; Although they may not have a high impact on the development of IFD&#44; their presence indirectly indicates a malfunction of the ventilation system&#44; lack of building maintenance or deficiency in the performance of internal protocols&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">In our personal experience&#44; when the patient&#44; family member or healthcare personnel are present during environmental monitoring&#44; it may be likely that yeast fungi&#44; such as <span class="elsevierStyleItalic">Candida</span> spp&#46; and <span class="elsevierStyleItalic">Rhodotorula</span> spp&#46; can be recovered&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">The frequency of performing measurements of non-viable particles suggests the need to requalify areas with grades A&#47;B within a maximum of 6 months&#44; and in areas with grades C&#47;D within a maximum of 12 months<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;9</span></a>&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">The frequency of measuring airborne fungi and&#47;or mesophilic bacteria will depend on the action policies of the infection control committee of each health center&#44; or on the situation that requires monitoring&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">In bone marrow transplant units &#40;BMTs&#41; grade A&#47;ISO class 5&#44; mycological control is recommended every 6 months<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#44; and&#47;or after any corrective action&#44; or when construction work is carried out in the sector or adjacent to the ward or hospital<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;7</span></a>&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">In operating theater suites&#44; the monitoring frequency will depend on the grade according to the described classification&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Grade A&#47;ISO class 5&#44; QHEPA&#44; TCB&#44; HOP&#58; each health facility will assess the monitoring frequency according to the risks&#44; which will be at least every 6 months<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">In conventional ventilated operating rooms grade B&#47;C&#47;D&#58; it is not advisable to perform systematic controls<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Final conclusions or recommendations</span>&#58; we consider that the monitoring of FF spores in hospital environments is an important step in a series of actions aimed at controlling and validating processes to prevent IFD&#46; Health centers present different degrees of complexity&#44; infrastructure&#44; human resources&#44; and quality assurance systems&#44; among others&#46; Due to this diverse reality&#44; we provide general recommendations for FF monitoring&#46; It is likely that there are situations that have not been covered in this manuscript&#46; Each institution will assess the need for environmental spores monitoring at relevant sites that pose a high risk of acquiring an IFD to the severely immunocompromised patient&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Hospital air quality control combines the monitoring of physical parameters &#40;temperature&#44; relative humidity&#44; acoustic level&#44; air movement&#44; velocity&#44; and pressure&#41;&#44; the counting of airborne &#40;non-viable&#41; particles &#8804;0&#46;5<span class="elsevierStyleHsp" style=""></span>&#956; to &#8805;5<span class="elsevierStyleHsp" style=""></span>&#956;&#44; and a mycological study of the air to assess the environmental fungal microbiota&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Except for BMT&#44; the hospital areas already mentioned above&#44; which include TCB&#44; QHEPA&#44; HOP&#44; are jointly monitored for FF and mesophilic bacteria<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;9</span></a>&#46; Intensive care areas&#44; burn units and conventional operating rooms lack a universally accepted standard for endpoints and interpretation of FF results&#59; probably because these wards house patients with lower risks of IFD&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">It is important to consider that the presence of any type of FF in high counts is an indicator of lack of building maintenance or deficiencies in the performance of internal protocols&#44; thus representing a potential risk&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Since these samplings are affected by a multifactorial and complex dynamics&#44; the criteria for the interpretation of results present variability among the standards that regulate air quality &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The procedures described are based on current regulations&#44; international guidelines&#44; and published works&#46; The infection control committee of each institution&#44; in permanent operation&#44; oversees the actions aimed at regulating and controlling processes to prevent infections&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">The monitoring of the fungal load in the hospital environment performed by the clinical mycology laboratory aims to validate hospital indoor air quality to ensure a controlled environment for immunocompromised patients to prevent fungal infections&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Funding</span><p id="par0310" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of interest</span><p id="par0315" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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      "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0005" class="elsevierStylePara elsevierViewall">Filamentous fungi in hospital indoor air are risk for severely neutropenic patients&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0010" class="elsevierStylePara elsevierViewall">Monitoring microbiology quality air to prevent invasive fungal diseases&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0015" class="elsevierStylePara elsevierViewall">Importance of mycology laboratory in air monitoring bone marrow transplant units&#46;</p></li></ul></p></span>"
    ]
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Air and surfaces in the hospital environment are a potential source of exposure to filamentous fungi &#40;FF&#41; that could cause invasive fungal diseases &#40;IFD&#41; in severely immunocompromised patients&#46; The prevalent FF in IFD are species from the genera <span class="elsevierStyleItalic">Aspergillus</span>&#44; <span class="elsevierStyleItalic">Fusarium</span>&#44; <span class="elsevierStyleItalic">Scedosporium</span>&#44; and those within the order Mucorales&#46; We have compiled regulations and described the procedures used in the clinical mycology laboratory to assess the presence of FF in areas at risk for the development of IFD&#46; The infection control committees of each establishment implement hospital policies to regulate and control processes aimed at preventing infections&#46; Fungal load monitoring is an important step in this process to validate air quality in order to ensure a clean and protected environment for severely immunocompromised patients&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El aire y las superficies en el ambiente hospitalario son una fuente potencial de exposici&#243;n a hongos filamentosos &#40;HF&#41; que pueden causar enfermedades f&#250;ngicas invasivas &#40;EFI&#41; en pacientes con inmunocompromiso grave&#46; Los HF prevalentes en EFI son especies que pertenecen a los g&#233;neros <span class="elsevierStyleItalic">Aspergillus</span>&#44; <span class="elsevierStyleItalic">Fusarium</span>&#44; <span class="elsevierStyleItalic">Scedosporium</span> y los del orden Mucorales&#46; Recopilamos regulaciones y describimos procedimientos que se utilizan en el laboratorio de micolog&#237;a cl&#237;nica para evaluar la presencia de HF en el ambiente de &#225;reas de riesgo para el desarrollo de EFI&#46; El comit&#233; de control de infecciones de cada establecimiento implementa pol&#237;ticas hospitalarias destinadas a regular y controlar procesos para prevenir infecciones&#46; La monitorizaci&#243;n de la carga f&#250;ngica es un eslab&#243;n en esta cadena y est&#225; dirigida a validar la calidad del aire&#44; con el fin de asegurar un entorno limpio y protegido para el paciente&#46;</p></span>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Procedure volumetric method&#44; surface sampling and gravimetric method inside the BSC&#46;</p>"
        ]
      ]
      1 => array:9 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Adapted from <span class="elsevierStyleInterRef" id="intr0005" href="http://www.edqm.eu/freepub">www&#46;edqm&#46;eu&#47;freepub</span><a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&#46;"
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">BMT&#58; bone marrow transplantation&#59; ISO&#58; International Organization for Standardization&#59; EU GMP&#58; European Union Guide to Good Manufacturing Practice&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The concordances between the two standards are indicated by the same color&#46; At rest&#58; monitoring is carried out with the room empty after cleaning&#46; In activity&#58; the monitoring is carried out with the usual personnel in the area&#46; The values indicate accepted limits of particles or microorganisms&#46; When counts are higher than indicated&#44; appropriate corrective action must be taken according to standard operating procedures&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; At grade D&#44; the operational limits are not predetermined&#46; Criteria are set by each institution based on risk assessment and routine data&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;b&#41; Any growth indicates the need for an evaluation of the monitored area to implement corrective measures&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#40;c&#41; The maximum number of viable microorganisms&#47;m<span class="elsevierStyleSup">3</span> is specified only by the EU GMP standard for Recommended Microbial Contamination Limits&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;d&#41; The last and fourth column indicates the specific hospital area classified depending on the clean air requirement based on its activity according to the standards&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tablaImagen" => array:1 [
                0 => array:4 [
                  "imagenFichero" => "fx1.jpeg"
                  "imagenAlto" => 1049
                  "imagenAncho" => 2917
                  "imagenTamanyo" => 219015
                ]
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Concordance between international standards &#40;ISO<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> and EU GMP<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#41; for air quality and correlation with the hospital area&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BMT rooms&#58; bone marrow transplant units&#59; BSC&#58; biological safety cabinet&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Volumetric method</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BMT rooms with fixed HEPA filters&#47;positive air pressure&#47;&#62;12</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">air changes&#47;h</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Aspergillus</span> spp&#46; &#60;1<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">7&#44;13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fusarium</span> spp&#46; &#60;1<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Fungal load at room &#60;10<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Fungal load at bathroom &#60;20<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BSC&#47;operating rooms with fixed HEPA filters &#8211; grade A &#8211; ISO class 5</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Fungal load 0<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mesophilic bacteria load 0<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Rooms and places surrounding aseptic areas &#8211; grade B &#8211; ISO class 5</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Aspergillus</span> spp&#46; &#60;1<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Fungal and mesophilic bacteria load &#60;10<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Conventionally ventilated operating rooms &#8211; grade C &#8211; ISO class 7</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Aspergillus</span> section <span class="elsevierStyleItalic">Fumigati</span> &#60;1<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Aspergillus</span> spp&#46; &#60;5<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Fungal and mesophilic bacteria load &#60;35<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> &#60;100<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Outpatient surgery&#47;labor rooms &#8211; grade D &#8211; ISO class 8</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Aspergillus</span> section Fumigati &#60;1<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Aspergillus</span> spp&#46; &#60;5<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Fungal and mesophilic bacteria load &#60;200<span class="elsevierStyleHsp" style=""></span>CFU&#47;m<span class="elsevierStyleSup">3</span> of air<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:1.0px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Gravimetric method</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BSC&#47;operating rooms with fixed HEPA filters &#8211; grade A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fusariosis associated with pathogenic <span class="elsevierStyleItalic">Fusarium</span> species colonization of a hospital water system&#58; a new paradigm for the epidemiology of opportunistic mold infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:11 [
                            0 => "E&#46;J&#46; Anaissie"
                            1 => "R&#46;T&#46; Kuchar"
                            2 => "J&#46;H&#46; Rex"
                            3 => "A&#46; Francesconi"
                            4 => "M&#46; Kasai"
                            5 => "F&#46;M&#46;C&#46; M&#252;ller"
                            6 => "M&#46; Lozano-Chiu"
                            7 => "R&#46;C&#46; Summerbell"
                            8 => "M&#46;C&#46; Dignani"
                            9 => "S&#46;J&#46; Chanock"
                            10 => "T&#46;J&#46; Walsh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/324501"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2001"
                        "volumen" => "33"
                        "paginaInicial" => "1871"
                        "paginaFinal" => "1878"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11692299"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The changing epidemiology of invasive fungal infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;A&#46; Enoch"
                            1 => "H&#46; Yang"
                            2 => "S&#46;H&#46; Aliyu"
                            3 => "C&#46; Micallef"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/978-1-4939-6515-1_2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Methods Mol Biol"
                        "fecha" => "2017"
                        "volumen" => "1508"
                        "paginaInicial" => "17"
                        "paginaFinal" => "65"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27837497"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0090"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for good manufacturing practice for medicinal products for human and veterinary use &#40;GMP&#41;&#46; Volume 4&#46; Annex 1&#58; Manufacture of sterile medicinal products&#46; Brussels"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "EU GMP"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "August 2022"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;health&#46;ec&#46;europa&#46;eu&#47;system&#47;files&#47;2022-08&#47;20220825&#95;gmp-an1&#95;en&#95;0&#46;pdf"
                      ]
                    ]
                  ]
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              ]
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            3 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ten-year air sample analysis of <span class="elsevierStyleItalic">Aspergillus</span> prevalence in a university hospital"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;G&#46; Falvey"
                            1 => "A&#46;J&#46; Streifel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jhin.2007.06.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hosp Infect"
                        "fecha" => "2007"
                        "volumen" => "67"
                        "paginaInicial" => "35"
                        "paginaFinal" => "41"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17719681"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Guide to the quality and safety of tissues and cells for human application&#44; EDQM 5th Edition 2022&#46; European Committee &#40;Partial Agreement&#41; on Organ Transplantation &#40;CD-P-TO&#41;&#46; Premises&#46; Part C&#46; Good Practice Guidelines for tissue establishments&#46; <a target="_blank" href="https://www.edqm.eu/en/guide-to-the-quality-and-safety-of-tissues-and-cells-for-human-application1">https&#58;&#47;&#47;www&#46;edqm&#46;eu&#47;en&#47;guide-to-the-quality-and-safety-of-tissues-and-cells-for-human-application1</a>&#46;"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "INCUCAI Resoluci&#243;n No&#46; 119&#47;2012&#44; p&#225;ginas 58-63&#46; Available from&#58; <a target="_blank" href="https://www.argentina.gob.ar/sites/default/files/03-cph-res_incucai_119_12.pdf">https&#58;&#47;&#47;www&#46;argentina&#46;gob&#46;ar&#47;sites&#47;default&#47;files&#47;03-cph-res&#95;incucai&#95;119&#95;12&#46;pdf</a> &#91;accessed 01&#46;08&#46;23&#93;&#46;"
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "INCUCAI Resoluci&#243;n No&#46; 25 2020 anexo 5932604&#95;1&#95; if-2020-04210496-apn-dct incucai-res-incucai-2520-anexo-1&#46; Available from&#58; <a target="_blank" href="https://www.argentina.gob.ar/sites/default/files/if-2020-04210496-apn-dct_incucai-res-incucai-2520-anexo-1.pdf">https&#58;&#47;&#47;www&#46;argentina&#46;gob&#46;ar&#47;sites&#47;default&#47;files&#47;if-2020-04210496-apn-dct&#95;incucai-res-incucai-2520-anexo-1&#46;pdf</a> &#91;accessed 01&#46;08&#46;23&#93;&#46;"
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "ISO 14644-1&#58;2015&#44; Cleanrooms and associated controlled environments &#8211; Part 1&#58; classification of air cleanliness by particle concentration&#46; ISO Technical Committee 209 &#40;ISO&#47;TC 209&#41;&#46;"
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Istituto Superiore per la Prevenzione e la Sicurezza del Lavoro&#46; Dipartimento Igiene del Lavoro&#46; Linee Guida Sugli Standard di Sicurezza e di Igiene del Lavoro nel Reparto Operatori&#46; Versione dicembre 2009&#46; <a target="_blank" href="https://www.inail.it/cs/internet/docs/linee-guida-igiene-reparto-operatorio.pdf">https&#58;&#47;&#47;www&#46;inail&#46;it&#47;cs&#47;internet&#47;docs&#47;linee-guida-igiene-reparto-operatorio&#46;pdf</a>&#46;"
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Invasive aspergillosis in neutropenic patients during hospital renovation&#58; effectiveness of mechanical preventive measures in a prospective cohort of 438 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:14 [
                            0 => "M&#46; Loschi"
                            1 => "C&#46; Thill"
                            2 => "C&#46; Gray"
                            3 => "M&#46; David"
                            4 => "M&#46;F&#46; Bagatha"
                            5 => "A&#46; Chamseddine"
                            6 => "N&#46; Contentin"
                            7 => "F&#46; Jardin"
                            8 => "H&#46; Lanic"
                            9 => "E&#46; Lemasle"
                            10 => "P&#46; Lenain"
                            11 => "A&#46; Stamatoullas"
                            12 => "H&#46; Tilly"
                            13 => "S&#46; Lepretre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11046-015-9865-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mycopathologia"
                        "fecha" => "2015"
                        "volumen" => "179"
                        "paginaInicial" => "337"
                        "paginaFinal" => "345"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25637199"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fungal diversity and Aspergillus in hospital environments"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:9 [
                            0 => "E&#46;O&#46; Mart&#237;nez-Herrera"
                            1 => "M&#46;G&#46; Fr&#237;as-De-Le&#243;n"
                            2 => "E&#46; Duarte-Escalante"
                            3 => "M&#46;C&#46; Calder&#243;n-Ezquerro"
                            4 => "M&#46;C&#46; Jim&#233;nez-Mart&#237;nez"
                            5 => "G&#46; Acosta-Altamirano"
                            6 => "F&#46; Rivera-Becerri"
                            7 => "C&#46; Toriello"
                            8 => "M&#46;R&#46; Reyes-Montes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5604/12321966.1203888"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Agric Environ Med"
                        "fecha" => "2016"
                        "volumen" => "23"
                        "paginaInicial" => "264"
                        "paginaFinal" => "269"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Invasive fusariosis in acute leukaemia patients &#8211; an outbreak in the haematology ward"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:10 [
                            0 => "A&#46;L&#46; Mohorea-Neata"
                            1 => "M&#46;C&#46; Ghita"
                            2 => "R&#46; Moroti"
                            3 => "A&#46; Ghiaur"
                            4 => "B&#46; Ionescu"
                            5 => "A&#46; Tatic"
                            6 => "M&#46;C&#46; Stancioaica"
                            7 => "A&#46; Bardas"
                            8 => "A&#46; Al-Hatmi"
                            9 => "D&#46; Coriu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/myc.13596"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mycoses"
                        "fecha" => "2023"
                        "volumen" => "66"
                        "paginaInicial" => "705"
                        "paginaFinal" => "710"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37128958"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A report of the aspergillosis Subcommittee of the Health Protection Surveillance Centre Scientific Advisory Committee"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "National Guidelines for the Prevention of Nosocomial Aspergillosis"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Libro" => array:1 [
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                        "link" => "https&#58;&#47;&#47;www&#46;hpsc&#46;ie&#47;a-&#47;respiratory&#47;aspergillosis&#47;guidance&#47;Aspergillus&#37;20Guidelines&#37;202018&#46;pdf"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0145"
              "etiqueta" => "14"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Design and maintenance of hospital ventilation systems and the prevention of airborne healthcare-associated infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Streifel Andrew"
                          ]
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                      ]
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                      "LibroEditado" => array:6 [
                        "editores" => "G&#46;Mayhall"
                        "titulo" => "Hospital epidemiology and infection control"
                        "paginaInicial" => "1268"
                        "paginaFinal" => "1280"
                        "edicion" => "4th ed&#46;"
                        "serieFecha" => "2012"
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "15"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nosocomial fungal infections&#58; epidemiology&#44; infection control&#44; and prevention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Suleyman"
                            1 => "G&#46;J&#46; Alangaden"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.idc.2016.07.008"
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                        "tituloSerie" => "Infect Dis Clin North Am"
                        "fecha" => "2016"
                        "volumen" => "30"
                        "paginaInicial" => "1023"
                        "paginaFinal" => "1052"
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                    ]
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