The Minnesota health department last week called a weeklong halt to elective knee surgery in the state because of the deaths of three knee-surgery patients at two hospitals.
All three died of infection, and the state's investigation is focused on wound infections caused by a strain of rare and deadly bacteria (See editorial, p. 36). But the medical director of St. Cloud (Minn.) Hospital, one of the two facilities involved in the outbreak, said one patient showed no evidence of infection at the site of incision and tested negative for the bacteria.
The patients had been "recovering nicely" when they developed severe abdominal pain a few days after surgery, deteriorated rapidly into septic shock and died, said Harry Hull, M.D., the state epidemiologist. A bacterium called clostridium was found in tests on the first victim, a 23-year-old man who died Nov. 11 after having surgery Nov. 7 at 669-bed St. Cloud Hospital. A 78-year-old man also died Nov. 11 after undergoing surgery Nov. 9 at St. Cloud, and a 60-year-old man died Nov. 16 after surgery at 99-bed Douglas County Hospital, Alexandria, Minn.
The Joint Commission on Accreditation of Healthcare Organizations said it is treating the deaths as sentinel events and has given the hospitals 45 days to prepare a root-cause analysis.
One strain of clostridium causes botulism, a life-threatening poison recently associated with bioterrorism, but state investigators ruled out that strain as well as another that causes tetanus, Hull said. Investigators working with the Centers for Disease Control and Prevention are "99% sure" of the exact strain found in the first victim. That strain rarely causes illness in humans but is serious when it does and can cause severe illness from a very small exposure, health department officials said.
Concern over the "nasty bug" led to the precautionary statewide shutdown of elective knee surgery, Hull said. At Minneapolis-based Allina Hospitals and Clinics, 114 knee surgeries had to be delayed at its 16 hospitals and a same-day surgery center, officials said.
No estimates of the financial repercussions were available, partly because the cause was still unknown, said Bruce Rueben, president of the Minnesota Hospitals and Healthcare Partnership. "We don't know how long it will last," he said of the stoppage. "Will it be just a week or will it last longer?" Despite the impact on surgery, "our highest and best need is to get to the bottom of this," he added.
During the moratorium, the health department will try to determine what the three deaths might have had in common. The two hospitals in central Minnesota are about 70 miles apart. Asked if the facilities had any overlap in staffing or services, Hull said, "Not (any) that would explain this outbreak."
Doctors and managers at St. Cloud were struggling to find similarities in the two deaths resulting from procedures at its surgical facility, said Dan Whitlock, M.D., vice president of medical affairs. The patients had different procedures done by different doctors in separate operating rooms using different medical teams, he said. One had general anesthesia, the other a spinal anesthetic, and they recovered in different rooms, he added.