Elusive bug stalls joints surgery

By ROSALEEN MacBRAYNE and REBECCA WALSH

Tauranga Hospital is trying to isolate the source of a serious infection which has halted all joint replacement operations.

Ten patients have become infected after undergoing orthopaedic operations.

Up to five patients are understood to have needed their artificial joint surgery repeated.

The hospital stopped joint implants two weeks ago when surgeons became concerned about the "unusually high" level of post-operative infections.

Seven orthopaedic surgeons said they would not perform operations until the operating suites were made completely safe.

General manager Alan Wilson said yesterday that the hospital hoped to know within days what had caused the infections.

But if an internal investigation could not isolate the source of the bacteria, an external audit might be necessary, he said.

Clinical director for orthopaedic surgery Bryan Thorn said five cases of "significant infection" had been confirmed and a further five were thought to be not as serious.

Although the 40-year-old operating theatres were "dated", they had been used for the past 20 years without "problems of this magnitude", he said.

"We've had an unacceptable rate of infections in joint implants. We don't consider it to be safe."

Isolating the source of the outbreak was complicated.

The hospital averages 10 to 12 joint replacements (mainly hips and knees) a week and expects to have a backlog of 40 cases. The hospital's five theatres are still in use and other orthopaedic surgery has been brought forward while joint replacements are on hold.

Mr Thorn said the seven orthopaedic surgeons were not prepared to resume the replacements until they were satisfied everything was as safe as possible.

Hospital management would not reveal what the offending bacteria was but Mr Thorn said it was "potentially much more serious" than the common staphylococcus and streptococcus strains.

Until now, infection rates at the hospital had been acceptable - well under 1 per cent. There was regular monitoring and auditing, he said.

Like operating theatres in many other New Zealand hospitals, Tauranga's theatres were "below contemporary standards for joint replacement surgery", but every precaution was taken to minimise the risk of infection.

New theatres, with modern technology which prevents the spread of bacteria, are included in plans for major redevelopment of the Tauranga Hospital campus expected to get Health Ministry approval within the next few weeks.

Bay of Plenty District Health Board chair Mary Hackett said the rise in infections had "come out of the blue" and the hospital had acted promptly to deal with it.

"We do not cut corners and that is why aggressive action has been taken," she said. "We need to find out where it is coming from and what we can do about it."

The age of the theatres did not affect infection control and no other surgical procedures had been stopped, said Mrs Hackett.

The chairman of the Western Bay of Plenty health liaison committee, John Jefferson, said his watchdog group met hospital management monthly to discuss concerns and he was confident problems were dealt with as they arose.

Professor Geoffrey Horne, president of the Orthopaedic Association, said that generally two types of infections occurred after artificial joint surgery: those that happened within 12 months of the surgery and those that happened years afterwards.

Staphylococcus and streptococcus infections were the most common.

Professor Horne said infections could occur in a number of ways. The air in operating theatres went through a filtering process to minimise the amount of bacteria present, but if the air quality was below the optimal level, infections could occur.

If operating equipment was not properly sterilised or a nurse or doctor touched part of the theatre that was not sterilised and then touched the patient's wound, infection could be spread.

Another possibility was that a staff member who was a "bacterial carrier" could unknowingly transfer the bacteria to the patient. Some patients could also have existing infections, he said.

Professor Horne said infection rates tended to range from 0.6 per cent to just over 1 per cent.

Theatre staff followed several procedures to maintain a sterile environment.

Air quality was also meant to be regularly checked.

Hospital problems

* October 2001 - A ward in the hospital is closed after an outbreak of the superbug MRSA (methicillin-resistant staphylococcus aureus). The bug can cause blood infection and pneumonia. It is difficult to contain and eradicate because it is easily transmitted and can survive in furniture, flooring and curtains.

* February 2002 - Air conditioning problems force the closure of five surgical theatres for nearly four days. New water cooling system is installed.

* September 2002 - The Health and Disability Commissioner criticises the hospital for not providing appropriately trained medical staff to deal with a 62-year-old woman, who died of a dissecting aortic aneurism.

* April 2003 - The commissioner requests an audit of the emergency department after finding it failed a 64-year-old man with deep vein thrombosis, who died after waiting four hours to see a doctor. The findings from a coroner's report into the death of a 24-year-old Te Puke man, who died of meningococcal septicaemia after unacceptable delays, were to be included in the audit.