Hospital officials in Montreal suspect that one patient died and another became gravely ill in February because of fungal spores in a city hospital's 40-year-old ventilation system. The Royal Victoria Hospital responded by closing 12 of its 15 operating rooms after Aspergillus was discovered in their air ducts. The move forced the hospital to move 2000 operations into other ORs around the city.
The surgical wing will be closed for 3 months while the ventilation system is cleaned and revamped, a hospital spokesperson says. High-efficiency particulate air filters are currently being installed in the operating block's ventilation system to deal with the Aspergillus spores, which are only 2 to 3 microns in size. Investigators speculate that the fungus infiltrated an aging ventilation system after renovations last summer.
“After DNA fingerprinting of environmental isolates and the patients' isolates, we're pretty sure that the ventilation system is the cause,” says Dr. Vivian Loo, the hospital's infection-control officer. A definitive link can only be made after lab results from the Centers for Disease Control and Prevention in Atlanta become available later this month.
Since the OR closures at the Royal Vic, Aspergillus has also been detected at the Montreal Neurological Institute and Hospital, but no facility closures were needed there. (Both are part of the 5-institution McGill University Health Centre [MUHC] network.) Montreal's Regional Health Board has responded with new guidelines for hospital renovations to prevent future outbreaks.
Questions about the physical state of the Royal Vic, which was constructed between 1883 and 1953, are nothing new — last year it was the target of patient complaints about its deteriorating physical plant, including rusty vent grates in the ORs.
“My fondest hope is that people will recognize that we're in an awkward situation, which highlights why we need to be in 1 new institution,” said Dr. Jonathan Meakins, the hospital's chief of surgery. (Despite some opposition, a new building to house the MUHC's 5 existing sites is slated to be complete by 2005, at a cost of $1.2 billion.)
The Montreal hospitals aren't the ones being affected by Aspergillus — a 1999 Health Canada report documented 24 Canadian hospitals facing the same problem. “Perhaps there's a call for routine testing of ambient air conditions,” said Dr. Denis Roy, director of professional services at the Royal Vic.
Most of the 2000 operations that had to be shifted were rescheduled at 5 other Montreal hospitals within 2 weeks of the OR closures. “We're doing 80% of our usual volume,” says Meakins.
The effect of this massive reorganization has been “profound,” he added. Entire OR teams — including surgeons, anesthetists, anesthesia technologists, nursing staff and orderlies — relocated on short notice, taking their surgical equipment and instruments with them. Patients already on waiting lists for elective surgeries now face longer delays, and surgeons have to work shifts to accommodate cases shoehorned into other hospitals' schedules.
“We're all a little depressed,” said Meakins. “On the one hand there's dismay that the staff is unable to provide their usual services, and angst that this disruption may go on for months. But on the other hand there's been an epiphany about how to solve this kind of problem. Other hospitals have been helping us and there's been cooperation from nurses, physicians, anesthetists and unions, who have all relaxed rules about who can work where and when.”
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Susan Pinker
Montreal
Figure. Dr. Vivian Loo: Ventilation system the cause? Photo by: Susan Pinker