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Different Types of Heater-Cooler Units and Their Risk of Transmission of Mycobacterium chimaera During Open-Heart Surgery: Clues From Device Design

Published online by Cambridge University Press:  28 May 2018

Richard Kuehl ,
Florian Banderet ,
Adrian Egli ,
Peter M. Keller ,
Reno Frei ,
Thomas Döbele ,
Friedrich Eckstein  and
Andreas F. Widmer
Richard Kuehl
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
Florian Banderet
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
Adrian Egli
Affiliation:
Division of Clinical Microbiology, University Hospital Basel, Switzerland Applied Microbiology Research, Department of Biomedicine, University of Basel, Switzerland
Peter M. Keller
Affiliation:
Institute of Medical Microbiology, University of Zurich, Switzerland Swiss National Center for Mycobacteria, University of Zurich, Switzerland
Reno Frei
Affiliation:
Division of Clinical Microbiology, University Hospital Basel, Switzerland
Thomas Döbele
Affiliation:
Division of Cardiac Surgery, University Hospital Basel, Switzerland
Friedrich Eckstein
Affiliation:
Division of Cardiac Surgery, University Hospital Basel, Switzerland
Andreas F. Widmer*
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
*
Address correspondence to Prof Dr Andreas F. Widmer, MD, MS, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland (andreas.widmer@usb.ch).
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Abstract

OBJECTIVE

Worldwide, Mycobacterium chimaera infections have been linked to contaminated aerosols from heater-cooler units (HCUs) during open-heart surgery. These infections have mainly been associated with the 3T HCU (LivaNova, formerly Sorin). The reasons for this and the risk of transmission from other HCUs have not been systematically assessed.

DESIGN

Prospective observational study.

SETTING

University Hospital Basel, Switzerland.

METHODS

Continuous microbiological surveillance of 3 types of HCUs in use (3T from LivaNova/Sorin and HCU30 and HCU40 from Maquet) was initiated in June 2014, coupled with an epidemiologic workup. Monthly water and air samples were taken. Construction design was analyzed, and exhausted airflow was measured.

RESULTS

Mycobacterium chimaera grew in 8 of 12 water samples (66%) and 22 of 24 air samples (91%) of initial 3T HCUs in use, and in 2 of 83 water samples (2%) and 0 of 41 (0%) air samples of new replacement 3T HCUs. Moreover, 7 of 12 water samples (58%) and 0 of 4 (0%) air samples from the HCU30 were positive, and 0 of 64 (0%) water samples and 0 of 50 (0%) air samples from the HCU40 were positive. We identified 4 relevant differences in HCU design compared to the 3T: air flow direction, location of cooling ventilators, continuous cooling of the water tank at 4°C, and an electronic alarm in the HCU40 reminding the user of the next disinfection cycle.

CONCLUSIONS

All infected patients were associated with a 3T HCU. The individual HCU design may explain the different risk of disseminating M. chimaera into the air of the operating room. These observations can help the construction of improved devices to ensure patient safety during cardiac surgery.

Infect Control Hosp Epidemiol 2018;834–840

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 7 , July 2018 , pp. 834 - 840
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

a

First authors with equal contribution.

References

REFERENCES

1. Kohler, P, Kuster, 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 2015;36:2745–2753.Google Scholar
2. Marra, AR, Diekema, DJ, Edmond, MB. Mycobacterium chimaera infections associated with contaminated heater-cooler devices for cardiac surgery: outbreak management. Clin Infect Dis 2017.CrossRefGoogle Scholar
3. Schreiber, PW, Sax, H. Mycobacterium chimaera infections associated with heater-cooler units in cardiac surgery. Curr Opin Infect Dis 2017;30:388–394.Google Scholar
4. Trudzinski, FC, Schlotthauer, U, Kamp, A, et al. Clinical implications of Mycobacterium chimaera detection in thermoregulatory devices used for extracorporeal membrane oxygenation (ECMO), Germany, 2015 to 2016. Eur Surveill 2016;21.CrossRefGoogle ScholarPubMed
5. Invasive cardiovascular infection by Mycobacterium chimaera associated with the 3T heater-cooler system used during open-heart surgery. European Centre for Disease Prevention and Control website. http://ecdc.europa.eu/en/publications/Publications/RRA-mycobacterium-chimaera-November-2016.pdf. Published 2016. Accessed April 15, 2018.Google Scholar
6. Hedge, J, Lamagni, T, Moore, G, Walker, J, Crook, D, Chand, M. Mycobacterium chimaera isolates from heater-cooler units, United Kingdom. Emerg Infect Dis 2017;23:1227.Google Scholar
7. BAG BfG. Mycobacterium chimaera: Fragen und Antworten. July 2014.Google Scholar
8. Troillet, N, Aghayev, E, Eisenring, MC, Widmer, AF. Swissnoso. First results of the Swiss National Surgical Site Infection Surveillance Program: who seeks shall find. Infect Control Hosp Epidemiol 2017;38:697–704.Google Scholar
9. Gesundheit Bf. Richtlinien zum Betrieb und zur Überwachung von Heater-Cooler Devices (HCDs) im Operationssaal. 2017.Google Scholar
10. Deggim-Messmer, V, Bloemberg, GV, Ritter, C, et al. Diagnostic molecular mycobacteriology in regions with low tuberculosis endemicity: combining real-time PCR assays for detection of multiple mycobacterial pathogens with line probe assays for identification of resistance mutations. EBioMedicine 2016;9:228–237.CrossRefGoogle ScholarPubMed
11. van Ingen, J, Kohl, TA, Kranzer, K, et al. Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study. Lancet 2017;17:1033–1041.Google Scholar
12. Chand, M, Lamagni, T, Kranzer, K, et al. Insidious risk of severe Mycobacterium chimaera infection in cardiac surgery patients. Clin Infect Dis 2017;64:335–342.Google Scholar
13. 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. Eur Surveill 2016;21.Google Scholar
14. Svensson, E, Jensen, ET, Rasmussen, EM, Folkvardsen, DB, Norman, A, Lillebaek, T. Mycobacterium chimaera in heater-cooler units in denmark related to isolates from the United States and United Kingdom. Emerg Infect Dis 2017;23:507–509.CrossRefGoogle ScholarPubMed
15. Williamson, D, Howden, B, Stinear, T. Mycobacterium chimaera spread from heating and cooling units in heart surgery. New Engl J Med 2017;376:600–602.Google Scholar
16. van Ingen, J, Kohl, TA, Kranzer, K, et al. Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study. Lancet 2017;17:1033–1041.CrossRefGoogle ScholarPubMed
17. Heater-cooler devices: information for health care providers and staff at health care facilities. US Food and Drug Administration website. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/CardiovascularDevices/Heater-CoolerDevices/ucm492583.htm. Published 2017. Accessed May 10, 2017.Google Scholar
18. Baker, AW, Lewis, SS, Alexander, BD, et al. Two-phase hospital-associated outbreak of Mycobacterium abscessus: investigation and mitigation. Clin Infect Dis 2017;64:902–911.Google Scholar
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