Updated Published Guidance on Heater Coolers in Cardiothoracic Surgery

Dear Colleague,

 The new joint guidance on heater coolers and infection has now been published and the previous guidance has been withdrawn. A Public Health England briefing note will also go to health protection teams and PHE and NHS microbiologists shortly. An email will also go to a cascade covering independent providers.

 The first web link below takes you to the complete guidance. The second link is the added information for cardiothoracic health care providers and includes a draft consent leaflet based on the wording used at Papworth.

 https://www.gov.uk/government/collections/mycobacterial-infections-associated-with-heater-cooler-units

 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/474218/Infections_associated_with_heater_cooler_units_version_1.pdf

It is the responsibility of individual units to implement the guidance. With regard to risk and consent this will vary from unit to unit based on known cases of such infections and the ongoing cultures from your heater cooler units. Overall the risk is estimated to be low (excerpt below) and there is advice on providing information to patients (excerpt below).

 ‘’RISK

If we take a theoretical group of 10,000 patients undergoing valve replacement, approximately 120 would be expected to have surgical site infections and 300-600 would have endocarditis by five years due to the normal background risk of infection. One additional M. chimaerainfection could be expected to arise within this number of patients and as such, the additional elevation in risk is minimal.’’

‘’Informing patients

The Duty of Candour requires that any patient harmed by the provision of a healthcare service is informed of the fact and an appropriate remedy offered. Any patient in whom you detect any infection that may be related to this device should be informed that this is a possibility.

Regarding consenting patients for surgery, SCTS advises that individual cardiothoracic centres should make a local decision on whether to inform their patients of the specific risks of infection associated with heater coolers. The decision should be made by cardiothoracic surgeons in consultation with the infection prevention and control team and microbiologist. Considerations when making this decision are the make and model of heater cooler used, microbiological findings from sampling of the devices, and any relevant cases of infection following surgery at that centre. An example of patient information for centres wishing to inform patients of the specific risk has been supplied with this pack.’’

 Yours sincerely,

 Simon

 Simon Kendall

Hon Sec SCTS

Cardiac Surgeon