Source: http://www.post-gazette.com, September 22, 2015
By: Sean D. Hamill
Infectious control experts from the state and federal governments are to be at UPMC Presbyterian and Montefiore hospitals today to try to figure out how to keep a possible mold outbreak from spreading, one day after UPMC said it was stopping all transplants at Presbyterian while it investigates.
The decision to shut down the transplant program and call in the federal Centers for Disease Control and Prevention as well as the Pennsylvania Department of Health came after UPMC said late Friday that there was a fourth person — a liver transplant patient at Montefiore — who had contracted a fungal infection. That person died at Montefiore on Thursday.
That announcement came five days after UPMC said it had one person — a lung transplant patient at Presbyterian — who contracted a fungal infection and was still battling the disease. Two days later UPMC said there were two earlier heart transplant patients at Presbyterian — one in June, another in October — who also had contracted fungal infections and later died.
It is not yet known whether the fungal infections played a role in the patients’ deaths, or exactly where the source of the mold is located.
“In consultation with the United Network for Organ Sharing, the nonprofit organization that manages the nation’s organ transplant system, UPMC has chosen to voluntarily and temporarily suspend all organ transplant operations at UPMC Presbyterian until we have completed our investigation and are satisfied that we’ve done all we can do to address the situation,” Steven D. Shapiro, UPMC chief medical and scientific officer, said in an emailed statement Monday night.
“We — working closely with the Pennsylvania Department of Health — have been in contact with the U.S. Centers for Disease Control and Prevention and leading fungal experts to review our next steps. In fact, a CDC team will be in Pittsburgh [Tuesday] to work alongside our experts as they conduct their investigation. We expect this temporary transplant postponement will be resolved in two to three days.”
Pennsylvania Department of Health Secretary Karen Murphy said in an emailed statement Monday night that the state asked the CDC to help with the investigation.
Mary Brandt, director of the CDC’s division that oversees fungal investigations, said last week that the CDC got a call to consult with state investigators, something that happens two or three times a year for outbreaks at different institutions.
The third UPMC patient, a lung transplant patient whose infection was confirmed Sept. 3, continues to fight the infection, and Dr. Shapiro said his condition was “guarded.”
The hospital still does not know the source of the mold and is investigating every possible location, including, he said, air seals around windows and doors, medical equipment, air filters and hospital laundry.
“As a precaution, linens for our immunocompromised patients will remain completely sealed in plastic from the moment they leave the cleaning facility until they arrive in our intensive care unit,” Dr. Shapiro wrote. “While we do not have evidence that linens were involved in the fungal infections at UPMC, they have been found to be the culprit in mold cases at other hospitals nationwide.”
Andy Streifel, an internationally known mold-outbreak expert who previously consulted with UPMC on how to handle construction-related issues at Presbyterian, was hired Friday by UPMC to help in investigating the current outbreak.
Before he was hired by UPMC, he told the Pittsburgh Post-Gazette in an interview that the news that all three of the first three patients had infections that began on the outside of their bodies was already a clue to him “that means [the source of the mold] is in the local environment” and was not brought into the hospital.
“And when that is the case, that means it is either from in the building or in the laundry,” he said. “Given what they got, that makes me suspicious of the laundry.”
Mr. Streifel said that about 15 years ago, before UPMC bought Mercy Hospital, Mercy had a mold outbreak that he traced back to infected laundry that was later used in patients’ rooms.
“I traced it back to dust stirred up by jack-hammering not far from the laundry area,” he said. “Laundry is usually clean when it’s done, but it can get contaminated after it is washed.”
If a transplant program intends to suspend operations for 15 or more consecutive days, it must provide written notification to its transplant candidates, recipients and living donors. The notice must explain why the program is being suspended and specify the options that patients have for transferring to another program, according to the United Network for Organ Sharing, the nonprofit that oversees the nation’s transplant system.
If patients want to transfer to another program, the center suspending operations must help them do so and flag the most urgent cases for transplant system officials. Patients’ waiting-list time is carried over to the programs they transfer to, according to UNOS bylaws.