Health Canada has issued an alert advising that a machine (called a heater-cooler machine) used to warm and cool a patient’s blood during heart, heart transplant, and lung transplant surgeries  has been linked to a rare infection caused by a type of bacteria called Mycobacterium chimaera (M. chimaera).

A heater-cooler machine is routinely used during heart, heart transplant, and lung transplant surgeries. There is potential for bacteria-contaminated water contained in the machine to be carried into the air of the operating room and possibly come in contact with the patient.

While the chances of getting this infection after heart, heart transplant or lung transplant surgery are very low, it is important patients and families know about the issue and are aware of the resources and supports available should they have questions or concerns.

At this time, no person in B.C. has been diagnosed with this infection as a result of heart, heart transplant or lung transplant surgery.

Questions You May Have

Are only patients who had heart, heart transplant or lung transplant surgery at risk?

Yes, patients who have had heart, heart transplant or lung transplant surgery since January 1, 2011 are receiving a notice letting them know of the low risk of a rare infection caused by M. chimaera. The infection has been linked to heater-cooler machines routinely used in heart, heart transplant and lung transplant surgeries. There is potential for bacteria-contaminated water contained in the machine to be carried into the air of the operating room and possibly come in contact with the patient. The chances of getting this infection after surgery are very low.

Has anyone in B.C. been diagnosed with this infection after surgery?

The BC Centre for Disease Control (BCCDC) keeps a record of people who have had this type of infection. Following a review of patient records, at this time, there is no record of any person in B.C. who has had this infection as a result of heart, heart transplant or lung transplant surgery.

BCCDC continues to investigate to determine if any patients in B.C. have had this infection as a result of exposure to a heater-cooler machine.

I have had other heart procedures (such as stents, pacemakers, defibrillators and ablations) in the past or am scheduled for one in future. Am I at risk?

No, heater-cooler machines are only used in surgeries where a heart-lung bypass machine is used and where the chest is opened up.

The following procedures do not require the use of a heart-lung bypass machine and will not put you at risk of the infection caused by M. chimaera:

• Stents
• Cardiac catheterizations
• Pacemaker procedures
• Implantable cardioverter defibrillator (ICD) procedures
• Cardiac synchronization therapy (CRT) procedures
• Ablation
• Electrophysiology studies
• Extracorporeal life support/ECMO
• Transcatheter valve procedures

What is M. chimaera?

M. chimaera is one of a group of common bacteria that sometimes cause lung infections or severe illness in people with weakened immune systems. These bacteria are commonly found in the environment from sources such as soil and water, including tap water. The chances of getting this infection after heart, heart transplant or lung transplant surgery are very low.

Is the infection caused by M. chimaera serious?

M. chimaera is usually not harmful to people. Only rarely has it caused infections in people with weakened immune systems.

What are the chances that I have or will get this infection?

The chances of getting this infection during surgery are very low. There have only been three confirmed cases in Canada linked to heater-cooler unit exposure, two in Quebec and one in Alberta. At this time, no person in B.C. has had this infection as a result of heart, heart transplant or lung transplant surgery.

A risk of bacterial infection at the surgical site is always possible during surgery. For most people, the benefits of having surgery outweigh the risk of infection.

What are the symptoms of an infection caused by M. chimaera?

Initial symptoms of an infection caused by M. chimaera may include:

• Extreme tiredness (fatigue)
• Weight loss
• Shortness of breath
• Unexplained fever or chills

Signs and symptoms in infants include fever and failure to thrive.

It is important to note that the signs of this infection are similar to many other common infections, so if you are feeling ill, it might not be from M. chimaera. See your doctor if you experience a combination of these signs lasting longer than a few days.

Call HealthLink BC at 8-1-1 to speak to a registered nurse any time of the day or night to ask about your symptoms and for advice on when to see a doctor. If you are having severe signs, contact your doctor right away or go to the nearest emergency.

How soon would I know if I have this infection?

The M. chimaera bacteria grow very slowly. Symptoms of an infection could appear from several months after or even up to five years after heart, heart transplant or lung transplant surgery.

What should I do if I have symptoms of infection?

If you have symptoms of infection for more than a few days, arrange to see your doctor. If you are having severe signs, contact your doctor right away or go to the nearest emergency. You may also call HealthLink BC at 8-1-1 to speak to a registered nurse any time of the day or night. A nurse can help you determine if your symptoms are severe and provide advice on when to see a doctor or visit the emergency.

How is the infection treated?

M. chimaera infection is treated with antibiotics.

Should everyone who had heart, heart transplant or lung transplant surgery receive antibiotics just in case?

No, this is not recommended. Taking antibiotics when you do not need them can cause antibiotics to lose their ability to control or kill certain bacteria over time. If this happens and you get an infection in the future, antibiotics might not work to treat it.

Can I be tested to find out if I am infected with M. chimaera?

No, there is no screening test to see if you have been exposed to M. chimaera during heart, heart transplant or lung transplant surgery. These bacteria grow slowly and are not detected without physical symptoms of infection. If you do not have any symptoms of infection, testing is not needed.

If I have been exposed to M. chimaera bacteria, could my family or friends get the infection?

No, this infection cannot be spread from person-to-person.

What resources and supports are available if I am concerned for myself or a family member, or if I have more questions?

If you have more questions or concerns, please call HealthLink BC at 8-1-1. HealthLink BC is available any time of the day or night in over 130 languages. In addition to answer your questions and discussing any symptoms you may have, HealthLink BC can provide you with information on free counselling services that are available to patients and families impacted by this advisory.

What if I am concerned or have a complaint about the care I received during a heart, heart transplant or lung transplant surgery?

To discuss concerns with your care or to make a formal care quality complaint, please contact the Patient Care Quality Office for the health authority where you had your surgery. You can find the Office for the health authority where you had surgery using our HealthLink BC Directory.

How are you telling patients about this advisory?

Every person in B.C. who has had heart, heart transplant or lung transplant surgery between January 1, 2011 and December 11, 2016 received a letter from Cardiac Services BC and the health authority where they had surgery to let them know of this low risk of infection. The letter included information about the infection and resources available should they require additional support. Patients who have had surgery after December 12, 2016 – the date of the public notification – will not receive a notification letter as this infection risk will now be discussed in overall risks of surgery.

Are you informing health care providers?

Health care providers around the province were also alerted about this infection risk so they are aware to monitor patients who may display symptoms of this type of infection.

Are heater-cooler machines still being used?

Yes, heater-cooler machines are an important and necessary part of heart, heart transplant and lung transplant surgeries. All hospitals that do heart, heart transplant and lung transplant surgery across the country, as well as in the United States, Europe and around the world, use this machine and are experiencing the same concerns and are investigating further. For most people, the benefits of having surgery outweigh the risk of infection.

Has the problem with the heater-cooler machines been fixed?

In B.C., the heater-cooler machines were already being cleaned following the maker’s instructions. When the makers of the machines sent out new cleaning instructions, hospitals started following them right away.

Your Health Authority

For information about the heater-cooler machine advisory from your health authority, click on the links below.

• Fraser Health: Heater-cooler machine advisory
• Island Health: Heater-cooler machine advisory
• Interior Health: Heater-Cooler Machine Advisory
• Northern Health: Cardiac Services BC – Heater-cooler machine advisory
• Vancouver Coastal Health: Heater-cooler machine advisory

For Health Care Workers

For more information about the heater-cooler machines and M. chimaera, visit Provincial Health Services Authority – Heater Cooler-Advisory.

Useful Websites

Healthy Canadians

Healthy Canadians is a Government of Canada website responsible for keeping Canadians informed about issues related to health and safety; and about recalls and alerts for health products, consumer products, food, and vehicles. For more information on the Heater-Cooler Devices alert, visit the alert listed below.

• Heater-Cooler Devices – Risk of Nontuberculous Mycobacteria Infection

Last Reviewed: June 30, 2017

The information provided in the Heater-Cooler Machine Health Advisory Health Feature has been adapted from the December 2016 notification letter Cardiac Services BC provided to patients who have had heart or lung transplant surgery in BC between January 1, 2011 and December 11, 2016.