Notice to patients that have had open heart surgery

Open heart surgery- risk of Myobacterial infection

There is a risk that heater cooler units (HCUs) used in cardiac surgery may be contaminated with Mycobacterium chimaera, and that exposure of patients to the aerosolised exhaust from these units in the operating theatre may lead to the development of a serious infection up to several years post-surgery. A small number of cases of serious Mycobacterium chimaera infections have been reported in the United States, the UK/Europe and one case in Australia (Qld).

At all Healthscope hospitals that perform open heart surgery, the following strategies are in effect to ensure the safety of our patients:

1. We work closely with the Department of Health and the manufacturers of the heater cooler units to ensure best practice
2. We strictly adhere to the most current version of the cleaning and disinfection instructions provided by the heater-cooler device’s manufacturer.
3. We only use sterile water recommended for the filling or refill the heater-cooler units
4. When making the ice needed for patient cooling during surgical procedures we use only sterile water or water that has been passed through the recommended filtration.
5. The heater-cooler’s vent exhaust is directed away from the operating table, or outside of the operating theatre to help prevent any droplets of water from the heater cooler’s water tank coming into contact with the patient
6. Regularly clean, disinfect and conduct regular maintenance for heater-cooler devices according to the manufacturers’ instructions to help prevent bacterial growth.
7. Regularly check for and immediately remove from service heater-cooler devices and accessories that show discoloration of internal surface’s or cloudiness in the fluid lines/circuits which may indicate bacterial growth.

Information for open-heart surgery patients

NSW Government | Health

Communicable diseases fact sheet

This advice is provided for patients in NSW who have had open-heart surgery and who may be concerned about reports of a risk of infection with Mycobacterium chimaera during surgery as a result of contamination of some heater-cooler units.

It is important to remember that the benefits of surgery outweigh the very small risk of infection associated with these devices.

Should you have any concerns or queries please contact your GP or cardiac specialist.

Mycobacterium chimaera – information for open-heart surgery patients.

FREQUENTLY ASKED QUESTIONS

What is the issue?

There is a risk that heater-cooler units used in cardiac surgery may have been contaminated with a rare bacterium called Mycobacterium chimaera (or M. chimaera), and that exposure of patients to these units in the operating theatre may lead to infections that can appear months after the surgery.

Infection of cardiac surgery patients with M. chimaera associated with a particular heater-cooler unit type (made by Sorin) was first recognised in 2012 in Switzerland. These devices, which are widely used around the world including Australia, are thought to have been contaminated during manufacture.

At least 50 patients worldwide have been identified with M. chimaera infections after cardiac surgery. The Therapeutic Goods Administration (TGA) has recently provided an update on this issue which noted a report of one patient infection with M. chimaera following open cardiac surgery in Australia. This the only known case reported in Australia linked to exposure to heater-cooler units.

What is Mycobacterium chimaera?

• Mycobacterium chimaera (M. chimaera) is one of a group of bacteria called non-tuberculous Mycobacterium bacteria (NTM) that are all commonly found in the environment, such as in water and soil.
• M. chimaera only very rarely causes infections in people. Infections tend to develop very slowly and in people who are more susceptible to infections because of other health conditions.

What are heater-cooler devices?

• Heater-cooler devices are often used during cardiac surgery because circulating blood and organs must be maintained at specific temperatures. How are heater-cooler devices associated with infection?
• There is the potential for M. chimaera or other bacteria to grow in a water tank in the heater-cooler units.
• Although the water in the heater-cooler unit does not come into contact with the patient’s blood or body fluids, contaminated water droplets from the tank may transmit bacteria through the air (aerosolize) and then find its way to the patient during the surgery.

Are certain groups of patients at higher risk of M. chimaera infection?

• M. chimaera and other NTM bacteria may cause infections in very ill patients including patients with compromised immune systems, underlying lung disease, diabetes, undergoing chemotherapy or certain invasive healthcare procedures, or receiving heart valve replacement surgery.

What has been done in NSW to reduce the risk?

• Sorin heater-cooler units susceptible to M. chimaera infection have been used in hospitals in Australia and some of these units have shown evidence of M. chimaera contamination.
• In NSW, facilities have reviewed processes to minimise the risk of infection. All heater-cooler units have and are continuing to be cleaned as per the manufacturers’ instructions. Affected Sorin heater-cooler units are being replaced or will undergo cleaning specified by the manufacturer and TGA.

What are the symptoms of M. chimaera infections?

• M. chimaera infections are slow-growing. Because of this it can take from several months to over a year for an infection to develop.
• Signs of a possible M. chimaera infection may include:

• fatigue
• difficulty breathing
• persistent cough or cough with blood
• fever
• night sweats
• redness, heat, or pus at the surgical site
• muscle pain
• joint pain
• abdominal pain
• weight loss
• nausea
• vomiting

What should I do if I am experiencing symptoms?

• Contact your local doctor if you are experiencing symptoms and inform them that you had open-heart surgery.

How is it treated?

• M. chimaera infections can be treated with combinations of specific antibiotics. Some patients who become infected may need prolonged treatment (from months to years).
• Additionally, although rare, some heart valve patients who develop M. chimaera infections after having cardiac surgery may require additional surgery. If untreated, M. chimaera infection could be potentially fatal.

Can I become infected through contact with someone who is infected with M. chimaera?

• No, M. chimaera infections are not contagious. They do not spread from person-to-person.

What should I discuss with my doctor prior to open-chest surgery?

• Always discuss the benefits and risks of your surgical procedure with your doctor.
• For most patients, the benefit of undergoing a surgical procedure recommended by their doctor far outweighs the risk of infection. Ask your doctor what to expect following your procedure and when to seek medical attention.