Pediatric Hospital’s Deaths From Aspergillus Infection Now at 6

November 21, 2019

Air filtration system blamed for Aspergillus outbreaks at children's hospital.

More deaths have been linked to the fungus Aspergillus at Seattle Children’s Hospital. Last week, Infection Control Today reported that Seattle Children’s Hospital was forced to shutter some of its operating rooms because Aspergillus had been detected. That marks the second time this year the fungus was discovered at the facility. The previous Aspergillus outbreak in May led to at least 5 infections and 1 death.

Now, after further investigation, the hospital has announced thatAspergillus has been in the air since at least 2001 and caused the deaths of 5 other childrenAspergillus spores can cause illnesses in people with weakened immune systems, damaged lungs, and asthma. Infections caused by Aspergillus include invasive aspergillosis, ABPA CPA, and aspergilloma.

“At the time, we believed most of these were isolated infections,” Jeff Sperring, MD, the hospital’s CEO, said in a statement. “However, we now believe that these infections were likely caused by the air handling systems that serve our operating rooms. Looking back, we should have recognized these connections sooner. As CEO, I hold myself-and Seattle Children’s-to a higher standard.”

John Lynch, MD, sits on the board of directors at the Infectious Diseases Society of America (IDSA). He tells ICT that one of the problems is that Aspergillus outbreaks are rare, and that there is no national system in place that tracks rare infections. “We don’t really know how common these outbreaks are,” he said. 

Currently, on a national level, infections resulting from hip and knee, cardiac thoracic, colorectal surgeries, and hysterectomies are tracked. “They’re tracked for the infections, but not for the pathogens that caused them,” says Lynch. “We do know that infections like this are much more common with complicated patients undergoing complex surgeries.”

Most of the operating rooms at the Seattle Children’s Hospital main campus will be closed until the end of January for installation of in-room, high-efficiency particulate air (HEPA) filters in every operating room. 

“HEPA is an extremely effective filtration system that removes 99.97% of particles from the air that passes through the filter,” Sperring said. “This is the highest level of filtration found in operating rooms today. These operating rooms will remain closed until the enhancements are fully in place.”

Lynch says that that’s “one thing we know. It’s associated with the way air is handled in operating rooms.”

Much of air flow occurs in the hard-to-reach infrastructure of hospitals. The buildings are often older. “How that works is always complicated,” said Lynch. “Some hospitals have air systems that handle humidity, some don’t. How to go about doing that isn’t abundantly clear.”

In the course of its investigation, Sperring says the hospital “will examine our culture, our leadership, and how our teams communicate problems and escalate concerns.”

 

IDSA recommends that the response to Aspergillus infection involve submitting tissue and fluid specimens for histopathologic, cytologic, and culture examination to diagnose invasive aspergillosis. “However, molecular techniques, such as DNA sequencing, should be used to identify Aspergillus species in cases that involve either isolates with atypical growth or concern for resistance,” the IDSA recommends.