Distribution characteristics of fungi on surfaces in the hospital environment: What have we overlooked?

Hospital environmental fungal contamination is a significant cause of healthcare-associated fungal infections, which are associated with high mortality rates in immunocompromised populations. However, current understanding of the distribution characteristics and high-risk colonization sites of fungi on hospital inanimate surfaces remains limited, hindering the development of targeted infection control strategies. A cross-sectional study was conducted in December 2024 in a large tertiary care hospital in central China. Using two-stage stratified sampling, 100 environmental surface samples were collected from 10 clinical departments. All samples underwent fungal culture and quantification, and culture-positive samples were further analyzed by 18S rRNA sequencing to characterize fungal community composition. A total of 20% of samples were culture-positive for fungi, and 7% exceeded the ECDC-recommended threshold of 5 colony-forming units per square centimeter (CFU/cm²). Water-related surfaces showed the highest culture-positive rate (32.1%), with the highest individual count observed in an endocrinology department handwashing pool (15 CFU/cm 2 ), followed by air disinfection machine vents and faucets. Aspergillus was the dominant genus (43.8% of isolates), and 70% of identified genera included WHO-listed priority pathogenic fungi. Water-related surfaces and ventilation equipment outlets are high-risk sites for fungal colonization. Current cleaning protocols are insufficient for these areas, requiring enhanced targeted surveillance and disinfection to reduce healthcare-associated fungal infection risk.