Decontamination of heater–cooler units associated with contamination by atypical mycobacteria

Garvey, Mark I.; Ashford, R. W.; Bradley, C.W.; Martin, Tracey Amanda; Walker, James T.; Jumaa, P.

doi:10.1016/j.jhin.2016.02.007

Cited by 67 publications

(85 citation statements)

References 9 publications

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“…Chand et al, sampled 45 HCUs across 12 different UK hospitals and nineteen (42%) were positive for M. chimaera. The results of these and other studies suggest that M. chimaera is a common contaminant of HCUs and that contaminated water within a HCU could be the source of M. chimaera infections 2,3,49,54 .…”

Section: Determining the Source Of Infections Related To Hcusmentioning

confidence: 64%

“…A follow-up investigation by Sax et al, described a total of 6 M. chimaera prosthetic valve endocarditis or vascular graft infections and an epidemiological link to HCUs utilised during surgery 1 Interestingly, the potential significance of HCUs in infection control was determined as early as 2002 in a publication that highlighted HCU microbial contamination, malfunctions, possible patient exposure routes, incompatibility of biocides with HCU components and problems regarding effective decontamination 48 . These are all issues that are again discussed in light of recent investigations 4,49 .…”

Section: Hcus As Reservoirs Of Ntmmentioning

confidence: 88%

“…Other opportunistic pathogens including M. chelonae, Aspergillus flavus and non-aspergillus moulds (Paecilomyces spp) have also been identified. The presence of L. pneumophila has also been detected 4,39,49,53 . The aerosolisation of L. pneumophila could represent a risk to users and surrounding staff 48 .…”

Section: Determining the Source Of Infections Related To Hcusmentioning

confidence: 99%

“…Extremely high heterotrophic plate counts (> 10 8 cfu/L) comprising a range of environmental Gramnegative organisms including P. aeruginosa, Sphingomonas paucimobilis, Stenotrophomonas maltophilia and Brevundimonas vesicularis have been reported 4,49 . Other opportunistic pathogens including M. chelonae, Aspergillus flavus and non-aspergillus moulds (Paecilomyces spp) have also been identified.…”

Section: Determining the Source Of Infections Related To Hcusmentioning

confidence: 99%

“…Such contamination implies a systemic failure of the decontamination regimen resulting in the formation of biofilms. The environmental conditions and usage of the HCU favours the growth of a wide range of microorganisms 4,49,54 . In operating theatres, the HCU is set up and connected to allow water to circulate through the unit, tubing, cardioplegia equipment and oxygenator some hours prior to the entry of the patient.…”

Section: Determining the Source Of Infections Related To Hcusmentioning

confidence: 99%

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Microbiological problems and biofilms associated with Mycobacterium chimaera in heater–cooler units used for cardiopulmonary bypass

Walker

Moore

Collins

et al. 2017

Journal of Hospital Infection

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Summary:The role of heater cooler units (HCUs) in the transmission of Mycobacterium chimaera during open heart surgery has been recognised since 2013. Subsequent investigations uncovered a remarkable global outbreak reflecting the wide distribution of implicated devices. HCUs are an essential component of cardiopulmonary bypass operations and their withdrawal would severely affect capacity for life-saving cardiac surgery. However, studies have demonstrated that many HCUs are contaminated with a wide range of microorganisms, including M. chimaera and complex biofilms. Whole genome sequencing of M. chimaera isolates recovered from one manufacturer's HCUs, worldwide, has demonstrated a high level of genetic similarity, for which the most plausible hypothesis is a point source contamination of the devices. Dissemination of bioaerosols through breaches in the HCU water tanks is the most likely route of transmission and airborne bacteria have been shown to have reached the surgical field even with the use of ultraclean theatre ventilation. Controlling the microbiological quality of the water circulating in HCUs and reducing biofilm formation has been a major challenge for many hospitals. However, enhanced decontamination strategies have been recommended by manufacturers and while not always effective in eradicating M. chimaera from HCUs, UK hospitals have not reported any new cases of M. chimaera infection, since implementing these mitigation strategies. Water safety groups in hospitals should be aware that water in medical devices such as HCUs can act as a vector in the transmission of potentially fatal water-borne infections.

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Section: Determining the Source Of Infections Related To Hcusmentioning

confidence: 64%