“I encourage all of you to take this survey, the issue at hand is primarily for the purpose of patient protection FIRST, and and how we adjust to it is obviously reactionary- but must be proactive and simply cannot be ignored or sidestepped”
I’m sure all of us are equally concerned regarding the surge of FDA reports and studies discussing the dissemination of mycobacterium chimaera, a slow-growing mycobacteria, that is aerosolized by Heater-Coolers during the conduct of open heart surgery and cardiopulmonary bypass.
I encourage all of you to take this survey, the issue at hand is primarily for the purpose of patient protection FIRST, and and how we adjust to it is obviously reactionary- but must be proactive and simply cannot be ignored or sidestepped with a mantra of “this has existed for a long time”. The first step, is getting on board with “what we don’t know”. After that we can formulate a game plan.
Please follow this link, take the survey, and trust me that the results are and will be at your fingertips. Survey on: “The H/C Pathogen Highway”.
While one or two manufacturers have been identified regarding their particular Heater Coolers, the jury is still not out as to the across-the-board implications for the other models out there.
Some institutional adjustments have gone as far as to extend the water lines and placing the HC outside of the OR suite, with another clinician operating the device controls. The theoretical 5 meter barrier limit (length of water lines)? Is it an issue? And how are institutions or perfusionists bypassing (no pun) it?
Plz feel free to render advice on how you are dealing with these issues, and share your ideas or suggestions on how to mitigate the impact.
Heater Cooler Survey
“Due to design characteristics, all HCD, regardless of manufacturer, are susceptible to the deposition of bacteria creating a coating (biofilm) on the synthetic surfaces that are exposed to water and contamination. The rate of reported incidents among different machine types is proportionate to the volume of market share of each manufacturer, and changing devices may not alleviate the problem. No device has been found to be less susceptible to biofilm deposition than another, and appropriate maintenance of the device by strict adherence to IFU guidelines are paramount in addressing the problem.” Al Stammers, CCP
Having read an article from Specialty Care regarding their approach to limiting the spread of microbial organisms from the use of heater coolers in the OR, I will list some of their recommendations (which I felt were very thorough- so thank you Mr. Al Stammers), and will add to that a survey to see what our colleagues are doing here in the US as well as the International Perfusion community to address this issue.
Here is a summary of the salient points of the article and there is a link to that Survey right below it.
Suggested Recommendations to Limit the Occurrence of NTM Infections in the OR (not possible in all sites)
1. Monitor HCD for bacterial growth through heterotrophic plate count (HPC), pseudomonas, and coliform bacteria, based on hospital infectious disease recommendations.
2. Reduce open entry points on oxygenator venous reservoirs by closing all luer ports not necessary for venting, and omit the use of syringes as “funnels” for the delivery of solutions either during priming of the circuit or throughout the case.
3. Where possible, position heart-lung machine in the laminar flow area of the OR table.
4. Limit turning on HCD to the times when needed.
5. Position HCD at the end of the OR bed at patient’s feet.
6. Do not empty tubing attaching HCD to heat exchanger(s) until AFTER the patient has left the OR.
7. Use gas evacuation system to capture air circulated at the HCD exhaust fan into hospital waste system.
8. Omit the use of non-disposable mounting system (holders) for oxygenators and cardioplegia heat exchange couplers.
9. At regular disinfection and cleaning cycles sterilize quick-disconnects (Hansen Couplers) according to hospital policy for instrumentation.
Additional Considerations for Limiting the Occurrence of NTM Infections in OR
1. Consider an alternate location of HCD outside of the OR.
2. Place HCD in encased housing.
3. When system is in use, place blanket over exhaust area of HCD, assuring that the device does not malfunction by limiting exhaust and over-heating.
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