You never know where and how a pathogen may enter a healthcare facility and wreak havoc. For the last several years, we have been focusing on environmental surfaces and shared patient care equipment and their contribution to infections - whether it be direct contact by a patient, or indirect by healthcare workers’ hands that have been contaminated from touching surfaces. Infections resulting from improperly reprocessed medical devices have also resulted in quite a bit of scrutiny about processes that need to be followed, ease of reprocessing in designing medical devices and the type of training needed by healthcare workers tasked with reprocessing.
There are some pathogens that are easier to determine the route of transmission and pinpoint how they may have managed to be passed to a patient. MRSA and C. difficile are recognized as two of the more significant pathogens transmitted via environmental surfaces. As such, a focus on these and other antibiotic-resistant pathogens has been given to ensure cleaning and disinfection methods are up to par, that disinfectant products have the capability of killing the pathogens of concern, and that facilities have a method to validate and monitor cleaning and disinfection practices.
Unfortunately, that does not stop other pathogens from arriving on the door step, or in the ORs of your facility. Case in point, Seattle Children’s Hospital has had to close most of its ORs after finding Aspergillus following air testing. This is the second time this year, ORs at the facility have had to close and the facility has attributed at least 6 deaths as a result. The facility has acknowledged that Aspergillus has been in the air of the ORs since at least 2001. Aspergillus is not an uncommon pathogen. In truth, it can before everywhere — indoors and outdoors. More than 180 different types of Aspergillus have been identified and while most are harmless, some types can cause a variety of diseases ranging from simple allergic reactions to life-threatening invasive disease. Illness from Aspergillus is referred to as Aspergillosis and rarely develops in healthy individuals - in fact, most people breathe in these spores every day without any issues. The risk of infection increases in individuals who have an underlying condition such as asthma, cystic fibrosis, etc. and/or in people who have taken corticosteroid drugs for a long period of time or who have weakened immune systems.
In Seattle, the presence of the mold is being blamed on deficiencies in the ventilation and purification systems. To correct the situation, the ORs will remain closed until the end of January so that in-room HEPA filters can be installed in every operating room. HEPA filtration is capable of removing more than 99.9% of particles from air that passes through the filters. It’s unfortunate that this situation has occurred and my heart goes out to the families impacted. I hope, however, that other facilities will take this as a wakeup call and check out their air, their infrastructure and ensure that something like this does not happen in another facility.