Seattle Children’s will reopen all of its 14 operating rooms Thursday, closed in May after the hospital detected a fungus that had infected six patients since last year, leaving one dead.

But even while hospital officials said Wednesday they’re confident the operating rooms are free of Aspergillus mold spores after installing new air-handling equipment and stringently cleaning and testing, administrators didn’t say whether the hospital had notified families of patients potentially exposed to the toxic mold last year.

Dr. Mark Del Beccaro, Children’s chief medical officer, said Wednesday the risk now to patients is “incredibly low.”

“Seattle Children’s is both sorry that it happened and deeply concerned and want to make sure that whatever we do when we are ready to open we are thinking about patient safety,” he said.

The mold was found last year and again in May, which prompted the operating-room closures and forced hundreds of patients to delay or seek surgeries elsewhere.

The hospital recognized through recent testing that its air-handling system had been spreading the fungus, Del Beccaro said, something officials hadn’t recognized after three patients became infected in 2018, he said.

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Del Beccaro didn’t answer some questions Wednesday about what and when hospital officials knew about the previous detection in spring 2018, which resulted in a patient’s death.

In May this year, after three other patients were found to be infected, Children’s notified about 3,000 patients who might have been exposed during the previous three months, Del Beccaro said.

When asked if the patients who had surgeries in spring 2018 were notified of the infections that year, Del Beccaro said he wasn’t sure and would have to check. He repeated several times no new cases would result from any potential exposure to Aspergillus last year.

Del Beccaro said the patient who died in 2019 was infected last year, but he declined to identify the patient, specify the type of surgery or say when exactly the death occurred.

“The children who we found in 2019 who had the infections belong to the same types of procedures that were very high risk,” said Del Beccaro.

Dr. Jeffrey Duchin, Public Health — Seattle & King County’s health officer, said he believes two of the cases were related to cardiac surgery, one was neurosurgery, two involved wound infections and another involved a deeper, more invasive tissue infection.

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Children’s reported the patient’s death to the state Department of Health (DOH) on May 20 — the date the hospital also reported the mold was present in four of its operating rooms.

[Related: 1 patient dies, 5 others infected by mold that closed Seattle Children’s hospital operating rooms]

Death caused by a fungus infection, like Aspergillus, is not a “notifiable condition,” requiring health-care providers to notify public-health authorities, according to DOH.

After the hospital notified the state health department about the infections detected in May, the agency opened separate investigations into whether Children’s was complying with state licensing requirements and meeting conditions for participating in the federal Centers for Medicare and Medicaid Services program.

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, which the state is now reviewing. Another site visit is planned to ensure the hospital is complying.

Del Beccaro said that after Aspergillus was detected last year, the hospital stepped up testing. The latest mold spores were found May 18 after routine testing. The hospital immediately closed four operating rooms.

Last year in June, hospital officials shut down two operating rooms and an equipment-storage room for three days, after detecting Aspergillus spores and after surgical patients started falling ill in spring 2018.

Del Beccaro said at the time they believed the mold entered through gaps caused by the configuration of the rooms. The hospital notified Public Health — Seattle & King County, which, in turn, brought in the Centers for Disease Control and Prevention (CDC).

Children’s reported the mold problem to the state in July 2018.

“We opened a state investigation and found no deficient practices,” Kristen Maki, a department spokeswoman, said in an email.

Duchin said the hospital and specialists from the CDC launched some environmental measures to improve Children’s air-filtration system. County health officials believed the mold was under control and the risk to patients was low, if not gone, Duchin said.

“But then something unexpected happened in 2019,” Duchin said. “Clearly, there was a risk that recurred.”

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In May of this year, after the initial four operating rooms were closed, surgeries continued in the remaining 10 on the Seattle campus until May 24, when the hospital shut down all 14. Each operating room had tested positive at one point during that time for Aspergillus, Del Beccaro said.

Public Health said it was not its duty to notify the public as it is when a new case of measles is confirmed. Duchin said the “level of notification” was up to Children’s.

Maki, the state health-department spokeswoman, said, “At this time, the situation is not at an outbreak level.”

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

Patients are typically infected when dust is stirred up during renovation or construction at a hospital, or through contaminated biomedical devices.

As far back as October 2017, the state’s health department had found Children’s wasn’t complying with “infection control” conditions required for its participation in CMS. During that review, inspectors found the hospital had “failed to develop and implement an effective infection prevention and control program” putting “patients, staff and visitors at risk of illness from communicable diseases.”

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The CMS compliance inspection this May found the hospital deficient in effective oversight of “quality improvement, infection control” that “put patients at risk of harm from pathogenic organisms.” That inspection determined partly through a review of 2018 and 2019 maintenance records the hospital was failing to ensure staff had “completed preventive maintenance of the hospital’s air handling system according to industry standards and manufacturer’s recommendations.”

The 2019 inspection turned up various instances between July 2018 and April of this year of technicians failing to complete routine maintenance on exhaust fans or replace pre-filters on its air handling systems on a timely basis. After both inspections, which put the hospital’s participation in the federal CMS program at risk, Children’s responded with detailed plans of corrections.

While Del Beccaro noted the hospital is tightening up its preventive-maintenance protocols for its air-handling system now, he downplayed the problems cited in the inspection as mostly minor.

“Even with those deficiencies, we had no infections for nine months,” he said. “So if those deficiencies were bad enough to allow infections to keep happening, we would have seen infections.”

After Thursday’s reopening, not all the operating rooms will be used right away, as a safety precaution, Del Beccaro said.

Among the improvements: The hospital switched to an updated and sanitized air handler, installed a new humidification system, sealed potential sources of air leaks in operating rooms, cleaned all the affected spaces several times and implemented new cleaning processes ⁠ — including one that uses ultraviolet light to disinfect surfaces.

About 1,000 surgeries have been postponed. Other surgeries have been moved to the cardiac catheterization facility on the hospital’s main campus in Seattle and its Bellevue campus. Most surgeries have been moved to Harborview Medical Center, University of Washington Medical Center, Swedish Medical Center and Mary Bridge Children’s Hospital in Tacoma.

Staff reporters Asia Fields, Daniel Gilbert and Elise Takahama contributed to this report.