Minnesota providers received clearance to resume elective knee surgeries last week, but state and federal investigators were still unsure about the circumstances of several deaths that prompted a weeklong halt to such procedures.
Three post-knee-surgery patients at two unrelated hospitals died within a two-day period last month, and disease specialists initially observed "a set of symptoms that suggested some sort of infectious disease process in all three cases," said Buddy Ferguson, a spokesman for the state health department.
The state called for a voluntary suspension of knee surgeries after a rare and deadly bacterium was found in one of the patients, a 23-year-old man who underwent knee surgery Nov. 7 at 669-bed St. Cloud (Minn.) Hospital (Nov. 26, p. 22). But no infectious agent was identified in the other two patients, and an investigation by the health department found no common factor connecting the deaths.
In addition, the investigation found nothing to suggest problems at St. Cloud or at the second facility, 99-bed Douglas County Hospital in Alexandria, Minn., about 70 miles northwest of St. Cloud. "People who are scheduled to have surgery at either of these facilities can proceed with total confidence in their safety," said Harry Hull, M.D., the state epidemiologist.
Specialists from the state and the federal Centers for Disease Control and Prevention also examined six other post-surgical deaths and illnesses from among several hundred reported in the wake of the statewide alert. No cases were clearly similar to the three deaths, Ferguson said. The investigation is now focusing on the source of the bacterium, Clostridium sordellii, isolated in tests on the 23-year-old man, he said.
The health department's call for a blanket suspension of a procedure was "a very unusual thing for a state to do" in response to a small number of deaths, said Joseph Cappiello, vice president of accreditation field operations at the Joint Commission on Accreditation of Healthcare Organizations. But he said it was "probably a wise thing" considering the increased vigilance surrounding infection incidents since the Sept. 11 terrorist attacks.
The JCAHO last week formalized its declaration of sentinel events at the two Minnesota hospitals after conferring with medical representatives, Cappiello said. The commission has given the facilities 45 days to complete a root-cause analysis of the cases.