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  • Montreal Royal Victoria Hospital mold problem: fungi: health effects



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    Montreal, mould / mold problems

    Several articles from This link was checked on Dec. 2006Montreal Gazzette Fungus linked to renovations Thursday 15 March 2001

    Health Canada report documents 24 cases of infestations at acute-care hospitals, AARON DERFEL

    A blitz of renovations at the Royal Victoria Hospital last summer has raised questions about whether the construction work might have caused the fungus infestation in the operating rooms and the infection of two patients. Renovations to hospitals are almost always to blame for outbreaks of aspergillus fungus, a Health Canada report warns. The report documents 24 cases of acute-care hospitals that were infested with aspergillus. This is the same fungus that was discovered in the air ducts of the Royal Vic. "Currently, no Canadian guidelines exist that address construction-related (hospital) infections and the preventive measures that are necessary to protect patients, health-care facility staff, and visitors at the time of construction or renovation," the March 1999 report concludes.

    The report notes that over a 20-year period, from 1976 to 1996, a total of 377 patients and employees were infected with aspergillus and other moulds at various hospitals across North America. At least 153 people died as a result of infections. In all of those cases, the Health Canada report blamed hospital renovations for the outbreaks. Last summer, the Royal Vic undertook the following renovation projects, among others: - Workers replaced the original 1916 slate roof atop the Vic's six-storey Ross Pavilion, abutting Mount Royal, with sheets of copper. - On the top floor of the 10-storey Women's Pavilion next door, built in 1926, rooms that once accommodated tired doctors at night were converted into a clinical "sleep laboratory." - Atop the "L" Building, just to the west of the Vic's main entrance on Pine Ave., a smaller section of leaky old slate roof was replaced.

    The Vic first detected the presence of aspergillus in the ventilation shafts of the operating block last month. The ventilation system is 40 years old. That's about twice the normal life span of commercial ventilation systems, experts have told The Gazette.

    The Health Canada report suggests that hospital ventilation systems in poor condition, coupled with renovations to nearby buildings, add up to a potentially hazardous mix:

    "Hospital ventilation systems have been implicated in the development of fungal outbreaks during periods of construction or renovation when vents were not closed properly, incorrect air pressurization in patient-care areas allowed airflow to move from dirty areas to clean areas, air exchange and exhaust were inadequate, and/or HEPA filters were not properly maintained."

    Last spring, the Montreal Regional Health Board - acting on a patient's complaint - ordered the Vic to replace a rusty ventilation grill in one of the operating rooms. Inspectors also urged the hospital to check and clean the ventilation system.

    On Dec. 22, the health board closed the file, satisfied that all the repairs were made.

    The Royal Vic refused repeated requests yesterday for an interview, saying they were too busy dealing with the crisis that has shut down the ORs for up to three months.

    "I have nobody to comment," public-relations official Chantal Beauregard said.

    "We're organizing ourselves so we can answer all questions at a press briefing on Friday."

    On Monday, during a tour of the ORs where cleanup crews were ripping open ceilings, officials were at a loss to explain how the fungus got into the system.

    "I can only speculate on that," said Denis L'Abbe, associate director of infrastructure for the McGill University Health Centre, whose affiliated hospitals include the Royal Victoria.

    "This could come in the front doors as you walk in. This fungus is omnipresent in any environment."

    Jim White, a former senior adviser of building science at the Canada Mortgage and Housing Corp., said the Vic's recent renovations might very well be the cause of its aspergillus outbreak.

    "Of course, it should be looked at as a possible cause, especially if there had been a leaky roof," White said.

    "If there had been a leaky old roof, and if, in fact, proper containment was not put in place when they went to work on the leaky roof, they definitely could have disturbed whatever mould growth was there."

    No renovations appear to have been carried out in the Vic's surgical building, where the infestation has taken place.

    But White, an expert on indoor air quality and mould contamination, said that even renovations at a distance could stir up a cloud of fungal spores that could get sucked into a building's vents and cracks.

    "If the building is upwind and being renovated, anything that would stir up a cloud of aspergillus could make its way into a building that is not pressurized," he said.

    Buildings that are pressurized have more air coming into them than exhausted outside.

    The extra air tends to leak out through cracks. That's a good thing if renovations are being carried out on an adjacent structure.

    However, if the building is not properly pressurized, air from the outside finds its way inside through cracks - along with the fungus, White explained.

    The Health Canada report points out an incident in which "construction activity adjacent to the hospital and a defective ventilation system in an old wing" were to blame for a 1982 aspergillus outbreak.

    Thirty-two patients were infected in that outbreak, and one person died. The report does not identify any hospitals.

    The aspergillus infestation at the Royal Vic is suspected to have infected a heart patient who died in January, sources say.

    Most healthy people will not become ill when they come into contact with aspergillus. But patients with weakened immune systems can die of the fungus, especially if they have been exposed to it while undergoing lengthy operations like open-heart surgery.

    Aspergillus spores are tiny, and they can remain suspended in the air for prolonged periods of time.

    The Health Canada report recommends that during hospital renovations, workers go to great lengths to minimize the raising of dust during construction and strive to prevent dust infiltration into patient-care areas.

    Hospital probes death - Royal Vic looks for link to fungus in OR air ducts Saturday 10 March 2001

    AARON DERFEL

    The Gazette

    The Royal Victoria Hospital is trying to find out whether a fungus found in the air ducts of its operating rooms is the same type that infected a heart patient who later died.

    Doctors discovered a fungus in the chest of a second patient two weeks ago, and infection-control experts are trying to determine through DNA testing whether it can be traced to the mould in the ventilation system, two sources have told The Gazette.

    The first patient underwent aortic valve surgery late last year and died in January. The second case involves a heart-transplant patient who is now severely ill.

    The two infections are what prompted the McGill University Health Centre to close a dozen operating rooms at the Royal Victoria at the end of February, and to cancel more than 200 surgeries so far. Each day the operating rooms stay closed, at least another 20 elective surgeries are added to the backlog.

    Ventilation System Replaced

    Although the investigation is not yet complete, the hospital is taking the extraordinary step of replacing the entire 40-year-old ventilation system that pumps air into the operating rooms. That should be done by the end of next week at a cost of almost $100,000.

    The fungus in the ventilation system has been identified as aspergillus, a group of moulds common in the northern hemisphere, especially in the autumn and winter. Although most people will not catch an infection after being exposed to aspergillus, the fungus is a serious problem in hospitals in North America and Europe. It poses a potentially fatal risk to patients with weak immune systems undergoing lengthy operations like open-heart surgery.

    "Oh, there's no question there's a problem that has to be fixed," Dr. Jonathan Meakins, chief of surgery at the Royal Vic, said of the ventilation contamination.

    "In a setting where you have cardiac surgery plus cancer surgery and immuno-suppressed patients, it is known that these patients are at risk of developing infection with this organism if it's in the air and it occurs in an operation where suction is being utilized."

    Hospital officials refused to provide details of the two infection cases, citing patient confidentiality.

    "We are worried about two cases and before we pass value judgment, we are waiting for scientific evidence," said Dr. Denis Roy, director of professional services at the MUHC, whose affiliated hospitals include the Royal Victoria.

    "This bug is so prevalent everywhere that to assume it comes from the OR vs. elsewhere would be scientifically dishonest. But I cannot comment on individual cases."

    Hospital officials have said they closed the operating rooms as a precaution after a routine test revealed the presence of aspergillus in the air ducts in February. In fact, it was the discovery of a fungus larger than a golf ball in the chest of the first patient in January that led the hospital to scour the ventilation shafts, a source said.

    Air-quality tests were conducted that month, but the results were negative. At the end of February, however, new test results came back positive, and that's when the ORs were closed.

    Roy denied that the hospital has been withholding information from the public, saying: "I don't think we're revealing a secret."

    The hospital has not yet informed patients who underwent surgery at the Royal Vic that they might have been exposed to the fungus, Roy said.

    Thirty-four patients who underwent surgery on two days when some of the ORs were reopened - they have since been closed again - are being monitored closely, the hospital said in a statement issued this week.

    Roy promised more information later. "When the situation is settled, we will have a debriefing," he said.

    "We will be looking at what has happened and we will do whatever is necessary, but not until we have the scientific evidence."

    A source, however, said it is clear that the hospital suspects the two patients were infected by the aspergillus circulating in the ventilation shafts.

    "One (of the cases) was a heart valve that was destroyed by aspergillosis and the other was a heart-transplant patient who had disseminated aspergillosis, in other words, was completely infected with aspergillosis," the source told The Gazette.

    Roy said the ventilation system is checked regularly and its filters are replaced about every six months.

    During the OR closings, patients requiring urgent surgery have been operated on elsewhere in the Royal Vic or at the Montreal General Hospital.

    On average, the Royal Vic performs up to 40 operations a day, but that has been ratcheted down to fewer than 10, Meakins said.

    He estimated that more than 200 scheduled surgeries have been "bumped."

    The nurses' union at the hospital is following the issue and has requested that the provincial workplace health and safety board intervene.

    "The information we have now is that it's not a health risk for employees, but we're still getting information," said Ro Licata, president of the union local.

    "This is fungus that is present in your house, your gardens. It's in many different places. Of course, anything that gets into a hospital - where you have people who are sicker and cannot fight things off the way a healthy person can - is of concern."

    The Royal Vic, one of the oldest hospitals in Montreal, is not alone in struggling to contain the spread of germs in its ventilation system, patient rooms and hallways. It's a major preoccupation for all hospitals.

    Last May, six staff members at a Calgary hospital got sick after authorities discovered a toxic mould that can cause bleeding in the lungs if inhaled in high doses.

    Later, Ottawa Hospital completed a $150,000 cleanup after three toxic fungus species were discovered in two operating-theatre changing rooms.

    No patients were infected in that incident.

    Experts predict that 200,000 patients across the country will fall ill this year with infected surgical wounds, blood infections and antibiotic-resistant bacteria - all contracted after they are admitted to hospitals.

    Of that number, more than 8,000 patients will probably die from those infections, according to the Community and Hospital Infection Control Association of Canada.

    The association blames budget cuts for turning Canadian hospitals into breeding grounds for deadly germs.

    - Aaron Derfel can be reached by phone at (514)987-2517 or by E-mail at aderfel@thegazette.southam.ca.

    ------------------------

    Thursday 22 March 2001

    Mould found at Neuro

    Same fungus as in Royal Vic ventilation system discovered near MRI area

    AARON DERFEL

    The Gazette

    High levels of aspergillus mould have been detected in the Montreal Neurological Hospital's sub-basement, where patients undergo sophisticated scans to diagnose cancer and other illnesses.

    The fungus was found in a drainage tunnel under the magnetic resonance imaging (MRI) department, according to an internal document obtained by The Gazette. Three employees took sick leave from that department three years ago, blaming moulds and noxious fumes from the MRI machines for their illnesses.

    The fungus is the same type that has contaminated the ventilation system of the Royal Victoria Hospital's operating rooms across the street. That outbreak is suspected to have infected two heart patients - one of whom died in January, sources say.

    On Monday night, workers scrubbed the Neuro tunnel with bleach - five months after a recommendation was made to get rid of the aspergillus.

    "It wasn't a priority," building manager Steven Black said yesterday in explaining the delay.

    The fact that the tunnel was disinfected after the aspergillus infestation was discovered at the Royal Vic is purely a coincidence, he added.

    The Royal Vic and Neuro are affiliated hospitals of the McGill University Health Centre. Last September, an MUHC hygienist - acting on a complaint - took air samples at various locations in the MRI and EEG (brain scan) departments as well as outside the hospital on University St.

    Potentially Hazardous

    The hygienist detected trace amounts of four types of airborne fungus - aspergillus, alternaria, penicillium and cladosporium.

    However, he singled out the drainage tunnel as a potentially hazardous source of aspergillus.

    "The result of samples taken from the underground tunnel in the MRI shows an elevated concentration of aspergillus," wrote Ata Nayebzadeh, the hygienist in the MUHC occupational health-and-safety department.

    "At this stage, it is hard to conclude that the tunnel environment may affect the MRI air quality. However, it is recommended that the interior surfaces of the tunnel be cleaned up by spraying and brushing of diluted concentration of bleach in order to reduce or eliminate any invisible mould growth."

    Aspergillus is a common fungus that thrives in the autumn and winter in northern climates. Most healthy people will not get sick after they are exposed to the fungus.

    But it poses a fatal risk to people with weakened immune systems who undergo chemotherapy or lengthy operations like open-heart surgery.

    Measuring aspergillus concentrations is difficult because there are no established norms, Nayebzadeh said in an interview. By comparison, there are norms for exposure to chemicals.

    "That is the problem with biological contaminants - there are no norms. So it's very hard to say what is a normal level or not. What I can say is that the aspergillus in the tunnel was very high compared with other areas and outdoor areas," he added.

    Employees Complained

    After major renovations to the Neuro in 1997, three employees complained about poorly vented fumes from chemicals used in the MRI machines. They also expressed concern about mould and bacteria in the drainage tunnel.

    The employees produced doctors' letters saying their illnesses were work-related.

    But the hospital disagreed after evaluations by its own health-and-safety physicians concluded there was no proof their work environment made them sick.

    Two employees are still on sick leave, while a third has been relocated elsewhere in the hospital.


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