Sunday, December 11, 2016
The risk of infection from heater-cooler systems in hospitals.
Invasive infections likely caused by the aerosolization of Mycobacterium chimaera from contaminated heater-cooler devices during cardiac surgery have been reported around the world and the outbreaks have prompted responses from major public health agencies. The Isolation and removal of heater-cooler devices from OR and other critical care areas could limit M. chimaera infections and keep patients from being infected by contaminated exhaust air. There is evidence that the coolers implicated in outbreaks were already contaminated from source when they arrived to the hospitals. Water outside the German plant where the heater-cooler device (HCDs) are manufactured was found to harbor M. chimaera. There was pretty good evidence that most of the devices were colonized at the factory site. HCDs are used with heart-lung machines to regulate body temperature during cardiothoracic surgeries and other medical procedures. The CDC says the devices are used in more than 250,000 procedures in the U.S. every year. The agency estimated that in hospitals where at least one HCD–related infection has been identified, the risk of a patient being infected with M. chimaera was between approximately one in 100 to one in 1,000. M. chimaera is a slow-growing species of nontuberculosis mycobacteria commonly found in soil and water, according to the CDC. Although it rarely makes people sick, symptoms of infection can be general and nonspecific and are often delayed. When the FDA linked the devices to infections in 2015, the CDC alerted health departments and providers around the United States and issued interim practical guidance advising facilities to remove contaminated units, maintain those in service and track reports about potential infections and the CDC also offers guidance on how to notify patients and health care providers about potential infection. There is no reliable disinfection procedures exist to eradicate the bacteria from HCDs, separating the devices from the air of critical medical areas is necessary to keep patients safe.more