[Integrated struggle against aspergillosis at the level of a single hospital or a hospital cluster].

Invasive nosocomial aspergillosis (INA) has become an increasing public health problem in hospitals whose inpatients are severely immunocompromised, i.e. in case of aplasia, bone marrow or organ transplants. The hospital's responsibility is engaged, all the more so since numerous INA cases have been reported during hospital construction work. Prevention measures must be implemented at the time of high risk activities (bone marrow graft, transplantation) or as soon as predisposed patients (aplastic) are admitted in hospitals. In case of hospital construction work, those measures must be adapted to the type of work and to the localization of the exposed patients. The first step of an integrated control strategy is to identify the aspergillus risk units in the hospital according to the immunocompromised state of their patients. The second step consists in the implementation, for those units, of effective protection measures concerning the control of hospital contamination sources, the patient's food, the architecture, the air treatment facilities, the staff organization and training. The third step is to apply a triple surveillance: epidemiological for the disease, technical for the air treatment facilities, mycological for the patients environment. In case of construction work, in or near the hospital, an evaluation of the Aspergillus risk level according to the construction work plan must be undertaken for each high risk unit. This risk level conditions the specific measures which have to be implemented. In the network of epidemiological INA surveillance of the Assistance Publique hospitals in Paris, those measures have been published as a recommendation guide.