The construction contractor CPB did not include patient-access areas such as balconies, air intakes, and windows near the site in its risk assessment.

A NSW Health report outlined four actionable recommendations, including increased air sampling and a dedicated fungal-surveillance committee, all of which have been accepted.

The hospital redevelopment is valued at about $940 million, and the balcony area was accessible to patients until handover to contractors closed it off.

Aspergillus, a common mould harmful to immunocompromised individuals, became airborne during construction and contributed to transmission, though it is not spread person-to-person.

Sydney Local Health District officials reaffirm their commitment to implementing the recommendations to prevent future harm to patients and families.

A fungal outbreak at Royal Prince Alfred Hospital in Sydney’s inner west has been linked to construction activity and is responsible for six aspergillosis infections in the transplant unit from late 2025, with a balcony area connected to a nearby construction site identified as the most likely exposure source.

Health authorities proposed and accepted stricter infection-control and construction-risk management measures, including updating infection-control plans, ensuring pre-construction risk coverage, prioritizing high-risk maintenance, and establishing a formal governance process for infection spikes during construction.

Investigators highlighted the balcony’s proximity to ongoing construction as the greatest exposure risk, though no single conclusive cause could be established.

The NSW Health Minister stressed hospital-wide implementation of recommendations and providing families with answers, amid criticism over delays in disclosing deaths.

After review by an expert panel, the ward was closed and later reopened on February 9 as it was deemed safe to operate.

Two deaths in the cluster are under a Serious Adverse Event Review, with failures to implement fungi monitoring cited as a contributing factor.

Construction work as part of a nearly $1 billion redevelopment began near the transplant ward in March 2025, with mould concerns raised in November 2025 that were not promptly addressed.