The infections led Pittsburgh-based UPMC to temporarily shut down its organ transplant program while the investigation occurred. The investigative team included fungal experts from around the nation as well as CDC officials.
Finding a source in this instance is difficult because the affected patients contracted three different species of mold, according to the report.
Even though no source of the infections was located, the Pittsburgh-based system put measures in place to prevent future infections, such as reviewing treatments to prevent fungal infections, using ultraviolet robots to disinfect the intensive care unit, replacing air handling micro filters and creating a new process for handling linens, according to the report.
Those measures should mitigate risk to future patients, according to the CDC and Karen Murphy, the Pennsylvania secretary of health. UPMC reopened the transplant program Sunday.
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