Heater–cooler units: contamination of crucial devices in cardiothoracic surgery

Götting, Tim; Klassen, Sheila; Jonas, Daniel E; Benk, C; Serr, Annerose; Wagner, Dirk; Ebner, Winfried

doi:10.1016/j.jhin.2016.02.006

Cited by 66 publications

(74 citation statements)

References 5 publications

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“…Gotting et al, also attributed the aerosolisation of water droplets to the operating fans; specifically a fan located in the upper rear part of the HCU 68 . Public Health England, Porton Down, carried out a controlled laboratory study to investigate the microbial aerosols generated by a naturally contaminated (decommissioned) 3T HCU that had been in service since 2002 4 .…”

Section: Determining the Source Of Infections Related To Hcusmentioning

confidence: 99%

“…Another is to place the HCU outside of the operating theatre. Gotting et al 68 positioned the HCU through a doorway, however, the positioning of the tubing connecting the cardiopulmonary bypass machine to the HCU prevented the theatre door from closing. This may have been the reason why the air samples from the operating room were positive and underlines the importance of controlling air flow in the whole operating area.…”

Section: Hcu Containment and Relocation Strategiesmentioning

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: 99%

Section: Hcu Containment and Relocation Strategiesmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…Dezenfektanlara direnç göstermeleri ve biyofilm formasyonu nedeniyle, bir kez kontamine olmuş HCD'lerin dekontaminasyonu, imkansız olmasa da oldukça zordur (4,33,34). Direkt fabrikadan kontamine olmuş 3T HCD'lerde (6,19) duvar ve boruları kaplayan biyofilmlerin kalması nedeniyle (4), uygula- nan çok sayıda dekontaminasyon sikluslarına rağmen M. chimaera elimine edilememiştir (33). Bir kez biyofilm geliştikten sonra, dekontaminasyon mikroorganizmayı azaltabilir; ancak tamamen ortadan kaldıramaz (33,34).…”

Section: Riskin Azaltılmasıunclassified

“…Direkt fabrikadan kontamine olmuş 3T HCD'lerde (6,19) duvar ve boruları kaplayan biyofilmlerin kalması nedeniyle (4), uygula- nan çok sayıda dekontaminasyon sikluslarına rağmen M. chimaera elimine edilememiştir (33). Bir kez biyofilm geliştikten sonra, dekontaminasyon mikroorganizmayı azaltabilir; ancak tamamen ortadan kaldıramaz (33,34). Şu ana kadar tüm M. chimaera infeksiyonları 3T HCD'lere bağlı olmakla birlikte HCD'lerin mikrobiyal kontaminasyonu çok sık görülmektedir ve bu durum belli bir modelle veya markayla sınırlı değildir (1,2,35).…”

Section: Riskin Azaltılmasıunclassified

“…Gerçekten de daha yoğun dezenfeksiyon işlemleri uygulayan araştırıcılar bile 3T HCD'den M. chimaera'yı eradike edememiştir (33,34,37). M. chimaera'nın saptanabilir düzeylerin altına baskılanabilmesi için perasetik asid ve tüm biyofilm içeren hortumların/boruların uzaklaştırılması gerekmektedir (37); ancak HCD'leri sürekli dekontamine edecek bir yöntem henüz gösterilmemiştir.…”

Section: Riskin Azaltılmasıunclassified

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