TODAY the Health Secretary is facing claims that not only are infection control experts being sidelined in the design process for new hospitals in Scotland, but that clinical staff who repeatedly attempt to raise concerns with managers over maintenance issues putting patients at risk are forced to whistleblow because “they are not being listened to”.

It emerged in January that two patients treated at the Queen Elizabeth University Hospital in Glasgow had contracted infections caused by Cryptococcus - a fungus found in pigeon droppings.

Read more: Infection experts 'sidelined' in hospital design

It is believed the bug entered the facility’s ventilation system and was spread through the air, but this should never have been able to happen and it remains unclear how it did.

An initial theory that the source was a plant room on the 12th floor where machinery was found covered in pigeon excrement has now been ruled out, according to the latest board papers from NHS Greater Glasgow and Clyde which reported that “air sampling results did not support this”.

The board said there had been no further cases of Cryptococcal infection since December 11, but investigations are continuing with support from UK experts.

Within days of the cases being reported, experienced architects came forward to publicly criticise the £842 million superhospital’s design.

Malcolm Fraser, an award-winning architect who has designed modern buildings including Dancebase in Edinburgh and Scottish Ballet in Glasgow, said it was not a “happy building”.

He said: “In this case it appears to be an issue with the mechanical ventilation and a gap that’s been left that pigeons can get in. Mechanical ventilation ducts are perfect places for cooking up virulent nasties, basically.”

Read more: A hospital designer's view on deadly pigeon infection outbreak

Robert Menzies, a retired architect who spent 40 years designing hospitals, said there was “either a flaw in the design or a flaw in maintenance”.

A report by Healthcare Improvement Scotland earlier this year also revealed how the adjacent children’s hospital had been plagued by build ups of potentially harmful microbes in its water systems before it opened.

Within months of it opening in May 2015, a child with cancer developed a bloodstream infection caused by Cupriavidus pauculus, a rare water-borne bacteria.

Read more: Source of deadly heart surgery mould infections remains a mystery

A string of subsequent water-borne infections led two paediatric cancer wards to be closed.

The troubles are not unique to Glasgow, however. In March it emerged that six patients had contracted rare fungal infections at the Royal Infirmary of Edinburgh (RIE) after undergoing aortic valve surgery between March 2017 and November 2018. Some died.

The infections were caused by three moulds - Lichtheimia corymbifera, Exophiala dermatitidis, and Aspergillus - not usually found in hospitals. Again, investigations are no closer to finding the source.

Crucially, the evidence to MSPs highlights potential gaps in the checks and balances of hospital design and maintenance of NHS estates, with boards effectively trusted to comply with guidance. No external body is routinely ensuring that these standards are met.

As Lewis Macdonald notes, “problems may only come to light once patients are infected”.