Royal Prince Alfred Hospital Fungal Outbreak Linked to Construction, Prompts System-Wide Maintenance Review

Fungal Outbreak at RPA Hospital Linked to Construction, Prompts NSW-Wide Review

An outbreak of Aspergillus fungal infections at Sydney's Royal Prince Alfred (RPA) Hospital's transplant unit in late 2025 resulted in the deaths of two patients and affected several others. The cluster of infections has been linked to ongoing construction for a $940 million hospital redevelopment project adjacent to the affected ward.

This incident has prompted an urgent, broader review of maintenance issues across New South Wales (NSW) public hospitals.

Between October and December 2025, six patients in RPA's transplant unit contracted Aspergillus fungal infections. Tragically, two of these patients died, with their deaths attributed directly to the fungal infection, and have been referred for a serious adverse event review. One patient remained in intensive care for several months following a December diagnosis, while other affected patients reportedly recovered.

Another patient, among the six affected, died from multi-organ failure associated with sepsis from an unrelated skin condition. A separate transplant patient's death due to a fungal infection was determined by a doctor to be unrelated to this specific outbreak.

Prior to 2023, RPA typically recorded an average of one Aspergillus infection per year in its transplant unit.

Investigations by the Sydney Local Health District (SLHD) linked the outbreak to a balcony accessible to patients, which opened to a construction site for the hospital's $940 million redevelopment. Sources state the construction began in March 2025 or 2023.

Aspergillus is a common mold whose airborne concentration can increase significantly during construction activities. It poses a high risk to immunocompromised individuals, such as organ transplant patients receiving immunosuppressant medication.

Concerns about the environment were raised prior to the official investigation. A nurse unit manager reported concerns regarding mold growth and water damage in patient rooms and bathrooms in September 2025, but a clear action plan was not provided at the time. A contractor's review later identified visible mold across four hospital floors and Aspergillus in a plant room on level four, potentially linked to heavy rain and water damage.

Following the diagnosis of multiple cases, hospital executives were informed, and an investigation was initiated on December 10. Infectious disease clinicians implemented immediate actions, including installing additional air filters, providing antifungal medication to patients, and alerting management.

Patients from the affected ward were relocated in December. The transplant unit was closed on January 2, and construction works near the ward were paused.

After a deep clean, ceiling resealing, and upgrades to air filtration systems, comprehensive air quality testing was conducted. Initial testing identified elevated Aspergillus levels in the transplant ward compared to other areas. The ward was reopened on February 9, after an expert panel, led by NSW Chief Health Officer Dr. Kerry Chant, deemed it safe, with subsequent testing indicating good air quality.

The outbreak was publicly disclosed by NSW Health Minister Ryan Park on a Wednesday, following a parliamentary order for documents. The state opposition criticized the government for delayed public disclosure, alleging a "cover-up."

Minister Park denied these claims, stating that NSW Health prioritized informing affected patients and families directly, guided by an expert panel to avoid "unnecessarily scaring people." He noted his office was notified on December 24, leading to the formation of the expert panel. Minutes from a January meeting indicate hospital staff expressed concern about being tasked with informing patients.

Dr. Kerry Chant acknowledged construction as a known risk factor in hospitals and stated that new advice for managing infections among transplant patients would be issued. NSW Premier Chris Minns described the situation as "not good enough" and expressed sorrow regarding the patient deaths. SLHD CEO Deb Wilcox noted that Aspergillus is common in dust and dirt, often associated with construction sites.

RPA Hospital was advised to implement four key recommendations, which the health district accepted:

• Update its infection control management plan.
• Ensure pre-construction documents comprehensively include all known impacted areas and potential risks.
• Establish a process for prioritizing maintenance and repair requests in high-risk areas.
• Create a formal governance process to respond to any increases in infections during construction.

Prompted by the RPA deaths, the NSW government initiated an urgent, system-wide review of maintenance issues across its public hospitals. The review identified 112 non-routine maintenance issues within the last year, with 74 resolved, 32 being addressed, and six under further investigation. These issues include pest outbreaks (cockroaches, possums, birds, pigeons), roof repairs at several facilities, and historical unreported pest infestations between 2012 and 2019 at major Sydney hospitals.

Minister Park stated that mold regularly occurs in NSW Health buildings, particularly after periods of heavy rain, and efforts are made to rectify and remove it promptly. He also stated that guaranteeing the absence of maintenance issues is unrealistic for any government, noting that some problems demand specialized expertise and time for resolution.

Despite these challenges, NSW Health reported meeting its targets for hospital-acquired infections and confirmed that all hospitals have passed independent assessments and met national standards for cleanliness over the past two years. Premier Minns highlighted a $10 billion investment over the next four years to upgrade and rebuild public hospitals across NSW.