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A Year in the Life of a Contaminated Heater-Cooler Unit With Mycobacterium chimaera?

Published online by Cambridge University Press:  05 May 2017

Mark I. Garvey ,
Craig W. Bradley  and
Jimmy Walker
Mark I. Garvey*
Affiliation:
Public Health England, National Infection Service, Biosafety, Air, and Water Microbiology Group, Salisbury, United Kingdom
Craig W. Bradley
Affiliation:
Public Health England, National Infection Service, Biosafety, Air, and Water Microbiology Group, Salisbury, United Kingdom
Jimmy Walker
Affiliation:
Public Health England, National Infection Service, Biosafety, Air, and Water Microbiology Group, Salisbury, United Kingdom
*
Address correspondence to Mark I. Garvey. University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB ([email protected]).
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Abstract

OBJECTIVE

Heater-cooler units (HCUs) have been shown to be a source of Mycobacterium chimaera infections. For the past year, weekly water samples have been taken from HCUs used at University Hospitals Birmingham (UHB) NHS Foundation Trust. We report the microbial contamination of the HCUs over a year detailing the decontamination regimes applied at UHB to reduce the microbial load.

DESIGN

Observational study

SETTING

UHB is a tertiary referral teaching hospital in Birmingham, United Kingdom, that provides clinical services to nearly 1 million patients every year. The UHB Cardiac department is one of the largest in the United Kingdom and provides treatment for adult patients with a wide range of cardiac diseases.

METHODS

Water samples taken from HCUs used at UHB for cardiopulmonary bypass surgery were sampled over a year to determine the number of microorganisms by membrane filtration. Various decontamination processes were employed throughout the year.

RESULTS

Varying total viable counts containing a wide variety of microorganisms were obtained from water inside the HCUs. No M. chimaera were isolated after replacement of the HCU internal tubing. Stringent decontamination regimes resulted in degradation of the HCUs and increased TVCs after several months.

CONCLUSION

More work is required to ensure effective decontamination processes to reduce the microbial load within the HCUs. Our studies indicate that weekly water sampling for TVC will be required indefinitely to monitor the water quality in these units as well as regular replacement of the tubing to control the build-up of biofilm.

Infect Control Hosp Epidemiol 2017;38:705–711

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 6 , June 2017 , pp. 705 - 711
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Sax, H, Bloemberg, G, Hasse, B, et al. Prolonged outbreak of Mycobacterium chimaera infection after open-chest heart surgery. Clin Infect Dis 2015;61:67–75.Google Scholar
2. Kohler, P, Kutser, SP, Bloemberg, G, et al. Healthcare-associated prosthetic heart valve, aortic vascular graft, and disseminated Mycobacterium chimaera infections subsequent to open heart surgery. Eur Heart J 2016;21:36:2745–2753.Google Scholar
3. Haller, S, Holler, C, Jacobshagen, A, et al. Contamination during production of heater-cooler units by Mycobacterium chimaera potential cause for invasive cardiovascular infections: results of an outbreak investigation in Germany, April 2015 to February 2016. Euro Surveill 2016;21: pii= 30215.Google Scholar
4. Chand, M, Lamagni, T, Kranzer, K, et al. Insidious risk of severe Mycobacterium chimaera infection in cardiac surgery patients. Clin Infect Dis 2016;64:335–342.Google Scholar
5. Sommerstein, R, Ruegg, C, Kohler, P, Bloemberg, G, Kuster, SP, Sax, H. Transmission of Mycobacterium chimaera from heater-cooler units during cardiac surgery despite an ultraclean air ventilation system. Emerg Infect Dis 2016;22:1008–1013.Google Scholar
6. Götting, T, Klassen, S, Jonas, D, et al. Heater-cooler units: contamination of crucial devices in cardiothoracic surgery. J Hosp Infect 2016;93:223–228.Google Scholar
7. Garvey, M, Ashford, R, Bradley, T, Martin, T, Walker, J, Jumaa, P. Decontamination of Sorin heater-cooler units associated with contamination with atypical mycobacteria. J Hosp Infect 2016;93:229–234.Google Scholar
8. Heater Cooler System 3T, operating instructions. Sorin Group website. http://www.livanova.sorin.com/products/cardiac-surgery/perfusion/hlm/3t. Published 2015. Accessed March 20, 2017.Google Scholar
9. Tortoli, E, Rindi, L, Garcia, MJ, et al. Proposal to elevate the genetic variant MAC-A, included in the Mycobacterium avium complex, to species rank as Mycobacterium chimaera sp. nov. Int J Syst Evol Microbiol 2004;54:1277–1285.Google Scholar
10. Kanamori, H, Weber, DJ, Rutala, WA. Healthcare-associated Mycobacterium chimaera transmission and infection prevention challenges: role of heater cooler units as a water source in cardiac surgery. Clin Infect Dis 2017;64:343–346.Google Scholar
11. Vijayaraghavan, R, Chandrashekhar, R, Sujatha, Y, Belagavi, CS. Hospital outbreak of atypical mycobacterial infection of port sites after laparoscopic surgery. J Hosp Infect 2006;64:344–347.Google Scholar
12. Schulze-Robbecke, R, Janning, B, Fischeder, R. Occurrence of mycobacteria in biofilm samples. Tuber Lung Dis 1992;73:141–144.Google Scholar
13. Wallace, RJ Jr, Brown, BA, Griffith, DE. Nosocomial outbreaks/pseudo-outbreaks caused by nontuberculous mycobacteria. Ann Rev Microbiol 1998;52:453–490.Google Scholar
14. Field safety notice. Cardiac surgery mycobacterium risks disinfection and decontamination of Sorin heater cooler devices. Sorin Group website. https://www.swissmedic.ch/recalllists_dl/12048/Vk_20150612_04-e1.pdf. Published 2015. Accessed March 20, 2017.Google Scholar
15. Mycobacterial infections associated with heater cooler units used in cardiothoracic surgery. Advice for providers of cardiothoracic surgery. Public Health England website. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/434189/M_chimaera_advice_for_providers.pdf. Published 2015. Accessed March 20, 2017.Google Scholar
16. Quick-start instructions: routine maintenance for heater cooler system 3T. LivaNova website. http://www.livanova.sorin.com/products/cardiac-surgery/perfusion/hlm/3t. Published 2016. Accessed March 20, 2017.Google Scholar
17. Rapid risk assessment: invasive cardiovascular infection by Mycobacterium chimaera potentially associated with heater cooler units used during cardiac surgery. European Centre for Disease Prevention and Control (ECDC) website. http://ecdc.europa.eu/en/publications/Publications/mycobacterium-chimaera-infection-associated-with-heater-cooler-units-rapid-risk-assessment-30-April-2015.pdf. Published 2015. Accessed March 20, 2017.Google Scholar
18. Medical device alert, MDA/2015/022. Heater cooler devices used during cardiac surgery: risk of infection with Mycobacterium species. All manufacturers. Medicines and Healthcare Products Regulatory Agency (MHRA) website. https://assets.digital.cabinet-office.gov.uk/media/557958c640f0b615b8000025/MDA-2015-022_Heater-coolers.pdf. Published 2015. Accessed March 20, 2017.Google Scholar
19. Sommerstein, R, Schreiber, PW, Diekema, DJ, et al. Mycobacterium chimaera outbreak associated with heater cooler devices: piecing the puzzle together. Infect Control Hosp Epidemiol 2017;38:103–108.Google Scholar
20. Medical device report. Circulatory System Devices Panel of the Medical Devices Advisory Committee. US Food and Drug Administration website. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/CirculatorySystemDevicesPanel/UCM504026.pdf. Published June 2016. Accessed July 29, 2016.Google Scholar
21. Contaminated devices putting open heart surgery patients at risk. Centers for Disease Control and Prevention website. http://www.cdc.gov/media/releases/2016/p1013-contaminated-devices-.html. Published 2016. Accessed March 20, 2017.Google Scholar