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Heater-cooler machine advisory

December 12, 2016

In response to an advisory issued by Health Canada, patients who had heart surgery, heart transplant surgery or lung transplant surgery in BC where heart-lung bypass was required are being notified of a small risk of infection associated with the type of machine used to warm and cool blood during surgery, known as a heater-cooler machine.

Letters are being issued by Cardiac Services BC and BC’s cardiac centres – Vancouver General Hospital, St. Paul’s Hospital (Vancouver), Royal Columbian Hospital (New Westminster), Kelowna General Hospital, Royal Jubilee Hospital (Victoria) and BC Children’s Hospital (Vancouver).

What we know
• Several people in North America have come down with a rare infection after heart, heart transplant or lung transplant surgery. The infection was caused by a type of bacteria called Mycobacterium chimaera (sounds like my-ko-back-tier-ee-um kye-mare-ah).
• In these cases, the infection was traced to the water tank in the heater-cooler machines used to warm and cool blood during the surgery.
• All hospitals that do heart, heart transplant and lung transplant surgery across the country, as well as in the United States, Europe and around the world, use this machine. They are experiencing the same concerns and are investigating further.
• At this time, we are not aware of any person in BC who has had this infection as a result of heart, heart transplant or lung transplant surgery. We are working with the BC Centre for Disease Control to determine if any patients in BC have had this infection as a result of exposure to a heater-cooler machine.
• The chance of getting an infection from a heater-cooler machine during surgery is extremely low. There have only been two confirmed cases in Canada, both in Quebec.
• In response to this concern, Health Canada, the United States Centers for Disease Control and Prevention, and the United States Food and Drug Administration issued advisories and recommendations for the cleaning of these machines.

What we are doing
• In BC, heater-cooler machines are cleaned following the maker’s instructions. When the makers of the machines sent out new cleaning instructions, hospitals started following the new instructions right away.
• We are sending a letter to the last known address on file for every person in BC who had heart, heart transplant or lung transplant surgery between January 1, 2011 and December 12, 2016 (the date of public notification) to let them know of this possible infection, even though the chances are very small.
• We have alerted health care providers around the province to make them aware of this infection risk so they can monitor their patients.

What we know about this type of bacteria
• The bacteria are commonly found in the environment (including in water and soil).
• They are typically not harmful to people who are exposed to them and they rarely cause illness in healthy people. Infection is more likely in people with weakened immune systems.
• The bacteria cannot be detected unless a person is showing signs of infection.
• The bacteria grow very slowly so any signs of an infection may not appear for many months or years. In cases where this infection was linked to heart, heart transplant or lung transplant surgery, the signs appeared from three months to up to five years after surgery.
• Infection from the bacteria can be treated with antibiotics.
• This infection cannot be spread from one person to another.

What patients can do
• Patients who feel well don’t need to do anything.
• Patients who have any combination of these signs of infection lasting longer than a few days should see their doctor:
     - Extremely tired all the time (fatigue)
     - Weight loss
     - Unexplained fever or chills
     - Shortness of breath
Please note these signs of infection are similar to many other common illnesses. If a patient has these signs, it may not be from these bacteria.

More information for patients
Patients who have questions or concerns can call HealthLink BC at 8-1-1. Patients outside of BC can reach HealthLink BC by calling 604-215-8110. HealthLink BC is available any time of the day or night and in 130 languages.

There is also information at www.healthlinkbc.ca/heater-cooler.

More information for health professionals
Health care professionals can find additional information in the Health Professionals area of PHSA’s website at www.phsa.ca/health-professionals.