A surgical patient at Seattle Children’s hospital contracted an infection from a fungus that was found in three operating rooms, the hospital confirmed Tuesday.

Tests at Seattle Children’s found  Aspergillus mold in three of the 14 operating rooms and two procedural areas at the hospital’s Seattle campus, adding a new chapter in an ongoing struggle with fungal infections at the region’s noted pediatric hospital.

Closure this week of the contaminated rooms comes about four months after all the hospital’s operating rooms were found to harbor Aspergillus and were closed for more than a month. It’s not clear how long the rooms will be closed due to the latest tests.

Testing for Aspergillus in the operating rooms and affiliated areas has been happening at least once a week since July 4, when they were reopened following the earlier infections. That testing will continue, Children’s spokeswoman Kathryn Mueller said in an email.

Three other patients were sickened by the fungus earlier this year at Seattle Children’s, after three patients who were infected in 2018. One of those patients died this past spring.

Children’s is monitoring a second patient who might also have contracted aspergillosis, the disease caused by the mold. Patients are typically infected when dust is stirred up during renovation or construction at a hospital, or through contaminated biomedical devices.

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Hospital officials are monitoring other patients considered at high risk of infection, Mueller said, although she did not say how many patients are being watched or how many people might have been exposed.

About 3,000 patients and their families were notified when the operating rooms were shut down in May.

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Scheduled surgeries might be canceled, postponed or done at other hospitals in the region including UW Medical Center, Harborview Medical Center, Children’s Bellevue campus and Mary Bridge Children’s Hospital in Tacoma. Some surgeries could be done in other parts of the Seattle campus, Mueller said.

Aspergillus is a common mold found outdoors and indoors that people breathe in daily without getting sick, according to the Centers for Disease Control and Prevention. People with lung disease or weakened immune systems, and especially organ or stem-cell-transplant patients, are at higher risk of developing aspergillosis, which can range from mild to serious, manifesting as an allergic reaction or infections in the lungs and other organs.

Children’s struggle with Aspergillus began in 2018. Two operating rooms and an equipment storage room were shuttered for three days in June of last year after tests detected Aspergillus spores and surgical patients started falling ill in spring 2018. Children’s reported the mold problem to the state Department of Health (DOH) in July 2018.

The problem in 2018 was thought to result from the configuration of the surgical rooms, while the problems this year were attributed to a gap in the array of small air filters in an air-handling unit that has since been shut down, Dr. Mark Del Baccaro, Children’s chief medical officer, said in an interview in August.

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Despite a deep cleaning of the operating rooms and efforts to seal any gaps, Aspergillus spores were found during testing on May 18. The hospital subsequently shut down four operating rooms. On May 24 the hospital shut down the remaining 10 operating rooms.

State inspectors did a site visit May 30 and issued the hospital a statement of deficiencies based on that visit. Children’s created a plan June 27 to correct those deficiencies. The state did a surprise inspection on Aug. 7 and signed off on Children’s plans to fix the problem.

This year’s inspection found various instances between July 2018 and April 2019 of technicians failing to complete routine maintenance on exhaust fans or replace pre-filters on its air-handling systems on a timely basis.

Another investigation focusing on infection control and the physical environment, which includes things like surfaces and the air systems of the operating rooms, has been approved by DOH, but has yet to begin, said DOH spokesperson Julie Graham.

The DOH investigation will also be used by the Centers for Medicare and Medicaid (CMS) to determine if Children’s is out of compliance with it’s Medicare and Medicaid program.

The deficiencies identified by the state during the summer put at risk the hospital’s participation in the federal program run by CMS. CMS decided not to rescind the hospital’s participation after DOH’s August inspection.