Fungus In the Chest of a Second Patient

Hospital Probes Death

by Aaron Derfel

The Royal Victoria Hospital is trying to find out whether a fungus found in the air ducts of its operating rooms is the same type that infected a heart patient who later died.

Doctors discovered a fungus in the chest of a second patient two weeks ago, and infection-control experts are trying to determine through DNA testing whether it can be traced to the mould in the ventilation system, two sources have told The Gazette.

The first patient underwent aortic valve surgery late last year and died in January. The second case involves a heart-transplant patient who is now severely ill.

The two infections are what prompted the McGill University Health Centre to close a dozen operating rooms at the Royal Victoria at the end of February, and to cancel more than 200 surgeries so far. Each day the operating rooms stay closed, at least another 20 elective surgeries are added to the backlog.

Ventilation System Replaced

Although the investigation is not yet complete, the hospital is taking the extraordinary step of replacing the entire 40-year-old ventilation system that pumps air into the operating rooms. That should be done by the end of next week at a cost of almost $100,000.

The fungus in the ventilation system has been identified as aspergillus, a group of moulds common in the northern hemisphere, especially in the autumn and winter. Although most people will not catch an infection after being exposed to aspergillus, the fungus is a serious problem in hospitals in North America and Europe. It poses a potentially fatal risk to patients with weak immune systems undergoing lengthy operations like open-heart surgery.

"Oh, there's no question there's a problem that has to be fixed," Dr. Jonathan Meakins, chief of surgery at the Royal Vic, said of the ventilation contamination.

"In a setting where you have cardiac surgery plus cancer surgery and immuno-suppressed patients, it is known that these patients are at risk of developing infection with this organism if it's in the air and it occurs in an operation where suction is being utilized."

Hospital officials refused to provide details of the two infection cases, citing patient confidentiality.

"We are worried about two cases and before we pass value judgment, we are waiting for scientific evidence," said Dr. Denis Roy, director of professional services at the MUHC, whose affiliated hospitals include the Royal Victoria.

"This bug is so prevalent everywhere that to assume it comes from the OR vs. elsewhere would be scientifically dishonest. But I cannot comment on individual cases."

Hospital officials have said they closed the operating rooms as a precaution after a routine test revealed the presence of aspergillus in the air ducts in February. In fact, it was the discovery of a fungus larger than a golf ball in the chest of the first patient in January that led the hospital to scour the ventilation shafts, a source said.

Air-quality tests were conducted that month, but the results were negative. At the end of February, however, new test results came back positive, and that's when the ORs were closed.

Roy denied that the hospital has been withholding information from the public, saying: "I don't think we're revealing a secret."

The hospital has not yet informed patients who underwent surgery at the Royal Vic that they might have been exposed to the fungus, Roy said.

Thirty-four patients who underwent surgery on two days when some of the ORs were reopened - they have since been closed again - are being monitored closely, the hospital said in a statement issued this week.

Roy promised more information later. "When the situation is settled, we will have a debriefing," he said.

"We will be looking at what has happened and we will do whatever is necessary, but not until we have the scientific evidence."

A source, however, said it is clear that the hospital suspects the two patients were infected by the aspergillus circulating in the ventilation shafts.

"One (of the cases) was a heart valve that was destroyed by aspergillosis and the other was a heart-transplant patient who had disseminated aspergillosis, in other words, was completely infected with aspergillosis," the source told The Gazette.

Roy said the ventilation system is checked regularly and its filters are replaced about every six months.

During the OR closings, patients requiring urgent surgery have been operated on elsewhere in the Royal Vic or at the Montreal General Hospital.

On average, the Royal Vic performs up to 40 operations a day, but that has been ratcheted down to fewer than 10, Meakins said.

He estimated that more than 200 scheduled surgeries have been "bumped."

The nurses' union at the hospital is following the issue and has requested that the provincial workplace health and safety board intervene.

"The information we have now is that it's not a health risk for employees, but we're still getting information," said Ro Licata, president of the union local.

"This is fungus that is present in your house, your gardens. It's in many different places. Of course, anything that gets into a hospital - where you have people who are sicker and cannot fight things off the way a healthy person can - is of concern."

The Royal Vic, one of the oldest hospitals in Montreal, is not alone in struggling to contain the spread of germs in its ventilation system, patient rooms and hallways. It's a major preoccupation for all hospitals.

Last May, six staff members at a Calgary hospital got sick after authorities discovered a toxic mould that can cause bleeding in the lungs if inhaled in high doses.

Later, Ottawa Hospital completed a $150,000 cleanup after three toxic fungus species were discovered in two operating-theatre changing rooms.

No patients were infected in that incident.

Experts predict that 200,000 patients across the country will fall ill this year with infected surgical wounds, blood infections and antibiotic-resistant bacteria - all contracted after they are admitted to hospitals.

Of that number, more than 8,000 patients will probably die from those infections, according to the Community and Hospital Infection Control Association of Canada.

The association blames budget cuts for turning Canadian hospitals into breeding grounds for deadly germs.