Seattle Children's Provider News

Statement from Seattle Children’s CEO Dr. Jeff Sperring on Aspergillus Infections and Main Campus Operating Room Closures

We are sharing the following statement from Seattle Children’s CEO Dr. Jeff Sperring with media at 10 a.m. this morning.

This is a heartbreaking time for all of us at Seattle Children’s. The work we do here is all about kids and their families. Patients, families and the community rely on us to provide safe, quality care. We’ve let them down.

We have been working to prevent Aspergillus infections in our operating rooms. To date, we have not been successful. Today, I am outlining our plan for comprehensive improvements to make our operating rooms safe.

First, I need to apologize. I apologize to the patients who developed infections and to their families. This is devastating for them – and for us. I apologize to all of our patients who depend on us and have been impacted; to every mom, dad or caregiver who has placed their confidence in us; to our community who has trusted us for 112 years; and to our team whose sole focus is the health and safety of our kids.

My job as CEO is to make this right and fix the problem so we can get back to taking care of the children who need us. We have a critical role in the community – and we take this responsibility incredibly seriously. We are here every day to do the right thing for patients and families. Patient safety is our highest priority.

As we have previously shared, Seattle Children’s has had seven Aspergillus surgical site infections since the summer of 2018. We are deeply saddened that one of those patients died.

As we have looked more closely at our history of Aspergillus infections, we believe there are connections between recent and past infections. Between 2001 and 2014, seven patients developed Aspergillus surgical site infections. Tragically, five of those patients died.

At the time, we believed most of these were isolated infections. However, we now believe that these infections were likely caused by the air handling systems that serve our operating rooms. Looking back, we should have recognized these connections sooner. As CEO, I hold myself – and Seattle Children’s – to a higher standard.

On Nov. 10, air-test results detected the presence of Aspergillus in several of our operating rooms. Shortly after, I made the decision to temporarily close most of our operating rooms at our main campus until the end of January to complete comprehensive improvements to our air-handling system. We are taking this decisive step because it is the best way to protect our patients.

During this period, Seattle Children’s will install a new rooftop air handler as well as custom-built, in-room high-efficiency particulate air (HEPA) filters in every operating room and adjacent supply area. HEPA is an extremely effective filtration system that removes 99.97 percent of particles from the air that passes through the filter. This is the highest level of filtration found in operating rooms today. These operating rooms will remain closed until the enhancements are fully in place.

In addition to addressing the air-quality issues in our operating rooms, we will conduct a rigorous, thorough review of the factors that led to this situation. Among other issues, we will examine our culture, our leadership, and how our teams communicate problems and escalate concerns.

We are continuing to engage with external experts to make sure we are doing everything possible to improve the safety of our care.

During this temporary closure of most of our operating rooms, Seattle Children’s will perform surgeries at partner hospitals including Harborview, Swedish, UW Medical Center and Mary Bridge Children’s Hospital.

We work hard to earn the trust of our community every day. We never take that for granted. We will do everything in our power to get this right, and we will not stop until we do. That’s what our community expects. That’s what our patients need and deserve.

Sincerely,

Dr. Jeff Sperring, CEO

Learn more about our plan to re-open our ORs, rescheduling surgeries and how to refer patients for surgery.

Plan for Installing HEPA and Re-Opening ORs

Dear Providers,

We are deeply sorry for the impact the air quality issues in our operating rooms (ORs) continue to have on our patients and families. Seattle Children’s remains committed to doing what’s right to keep our patients safe.

Dr. Mark Del Beccaro, SVP and Chief Medical Officer

Mady Murrey, SVP and Chief Clinical Officer

Dr. Jeff Ojemann, SVP and Surgeon-in-Chief

Plan for Installing HEPA and Re-Opening ORs

On Wednesday, Nov. 13, we closed our main operating rooms (ORs) at the hospital to inspect our air handling system and determine the appropriate corrective actions.

After careful consideration and in consultation with outside experts, we have decided to proceed with the immediate installation of custom in-room HEPA filtration in 10 ORs and two equipment storage rooms, and to continue with the planned installation of the new air handling system. We had previously planned to build in-room filtration systems room-by-room in order to minimize disruption to our patients, and have already completed this work in three rooms. The room-by-room installation was previously scheduled to be completed by July 2020.

Our patients’ safety is our top priority and we remain committed to doing what’s right to keep them safe.  HEPA is an extremely effective filtration system that removes more than 99% of particles from the air passing through the filter. Installing in-room HEPA filtration requires custom-building a system for each OR – an extraordinary measure – but one that we know is the right thing to do for our patients and families.

To allow for the installation of the new filtration systems, 10 ORs will remain closed until the end of January. We will continue to perform surgeries in the four remaining ORs, three of which already have HEPA filtration. Cases that must be done at Seattle Children’s will be performed in the ORs with HEPA filtration. Only those surgeries that pose little or no risk of infection will be performed in the OR that does not yet have HEPA filtration. After February, the one remaining OR will receive its in-room HEPA filtration system.

We know this closure will result in the postponement of many surgeries, and we are sorry for the impact this will have on our patients and families. We are confident this is the safest option for our patients.

How does this affect patients who are referred with possible surgical needs?

Please continue to refer patients by calling our ED Communications Center at 206-987-8899. We will review potential surgical patients on a case-by-case basis with the appropriate surgical specialists and with our Surgeon-in-Chief. We will continue to divert some cases to other local hospitals and perform additional surgeries at our Bellevue Clinic and Surgery Center.

How does this affect patients currently scheduled for surgery at Seattle Children’s?

Our surgery coordinators will be contacting families to help them reschedule their procedures. We will review surgical patients on a case-by-case basis with the appropriate surgical specialists and with our Surgeon-in-Chief. If a family contacts you with a question about their child’s scheduled surgery, please ask them to call their surgery clinic at Seattle Children’s for assistance.

We understand the impact that postponing surgeries has on our patients and families, and are deeply sorry for the inconvenience. We are grateful for our families’ understanding and your partnership and support during this period.

Is my patient at risk if he/she had surgery at Seattle Children’s recently?

We have been actively monitoring all high-risk patients since re-opening our ORs in July and have contacted those families.

Where should I direct families who have questions?

If your patient or family has a concern, please ask them to visit our website for the most up-to-date information or call 206-987-2550. If they need an interpreter, they may call 866-583-1527 and ask to be connected to this number: 7-2550.

What if I have more questions?

If you would like to speak with Seattle Children’s leadership team directly, please contact Dr. Jeff Ojemann, Seattle Children’s Surgeon-in-Chief (206-987-2544 or Jeffrey.Ojemann@seattlechildrens.org). You may also contact Seattle Children’s Chief Medical Officer, Dr. Mark Del Beccaro (206-987-2005 or mark.delbeccaro@seattlechildrens.org).

If you have an urgent clinical concern, please call the Provider-to-Provider Line at 206-987-7777 and ask to speak to the specific surgical service on call.

Air Quality in Operating Rooms – November 2019

Dear Providers,

We are deeply sorry for the impact the air quality issues in our operating rooms (ORs) continue to have on our patients and families. Aspergillus is again present in some of our ORs. Out of an abundance of caution, we have closed all main ORs at our main campus in order to investigate the air handling system and take corrective actions. Seattle Children’s remains committed to doing what’s right to keep our patients safe.

The duration of the OR closures is still being determined.

We have provided a Q&A below to help answer your questions. We will update you again when we have new information to share.

Dr. Mark Del Beccaro, SVP and Chief Medical Officer

Mady Murrey, SVP and Chief Clinical Officer

Dr. Jeff Ojemann, SVP and Surgeon-in-Chief

 

What is happening?

On November 10, routine air tests detected Aspergillus in three operating rooms and two procedural areas. Aspergillus is a common mold often present in the air we breathe. However, in some instances it can cause complications for surgical patients.

What are we doing in response?

We have closed all main ORs at our main campus. The duration of the operating room closures is still being determined.

Some surgical cases may be postponed, diverted to other local hospitals temporarily, or performed at one of our community-partner sites by Seattle Children’s surgeons who have privileges at that site. We will perform some procedures at our Bellevue Surgery Center or at other sites on our main campus that are not in the main ORs.

We have also self-reported the issue to the Washington State Department of Health and Public Health – Seattle & King County.

Have patients been affected?

We recently confirmed one new Aspergillus surgical site infection, and continue to investigate one other potential infection.

How does this affect patients who are referred to the ER with possible surgical needs?

Please continue to refer patients by calling our ED Communications Center at 206-987-8899. We will review potential surgical patients on a case-by-case basis with the appropriate surgical specialists and with our Surgeon-in-Chief.

How does this affect patients currently scheduled for surgery at Seattle Children’s?

Our surgery coordinators will be contacting families to help them reschedule their procedures. We will review surgical patients on a case-by-case basis with the appropriate surgical specialists and with our Surgeon-in-Chief. If a family contacts you with a question about their child’s scheduled surgery, please ask them to call their surgery clinic at Seattle Children’s for assistance.

We understand the impact that postponing surgeries has on our patients and families, and are deeply sorry for the inconvenience. We are grateful for our families’ understanding and your partnership and support during this period.

What should PCPs be monitoring for?

Signs of Aspergillus infection may include:

  • Redness
  • Swelling or drainage from the surgical site or fever
  • Neurosurgery patients might experience headache or a stiff neck.

If you have a clinical concern, you may call the Provider-to-Provider Line at 206-987-7777 and ask to speak to Infectious Disease.

What is causing Aspergillus to be present in the operating rooms?

At this time, the source of Aspergillus in the operating rooms is unknown and we are actively investigating.

What did Seattle Children’s do previously to address its air quality issues?

During the summer of 2019, we implemented multiple improvements recommended by outside industrial hygiene experts. These included:

  • Removing our previous air handling and purification system and switching to a newer air handler, which has been upgraded, cleaned, sanitized and tested to verify proper performance.
  • Installing and testing a new humidification system.
  • Sealing potential sources of air leaks in all of the operating rooms.
  • Extensively and repeatedly deep cleaning all of our operating rooms and core rooms.
  • Adding a new device to our operating room cleaning protocol that emits ultraviolet light to disinfect surfaces.
  • Continuing to monitor and test our air handling system in an effort to maintain a safe environment for our patients.

To validate that our operating rooms were safe for patient care, this summer we invited the Centers for Disease Control and Prevention (CDC), the Washington Department of Health and Public Health – Seattle & King County to tour our facilities, assess our safety protocols and share in our learnings. They confirmed we have taken appropriate actions to reduce the risk of future Aspergillus infections.

Where should I direct families who have questions?

If your patient or family has a concern, please ask them to visit our website for the most up-to-date information or call 206-987-2550. If they need an interpreter, they may call 866-583-1527 and ask to be connected to this number: 7-2550.

What if I have more questions?

If you would like to speak with Seattle Children’s leadership team directly, please contact Dr. Jeff Ojemann, Seattle Children’s Surgeon-in-Chief (206-987-2544 or Jeffrey.Ojemann@seattlechildrens.org). You may also contact Seattle Children’s Chief Medical Officer, Dr. Mark Del Beccaro (206-987-2005 or mark.delbeccaro@seattlechildrens.org).

If you have an urgent clinical concern, please call the Provider-to-Provider Line at 206-987-7777 and ask to speak to the specific surgical service on call.

New Endocrinology Algorithms

Seattle Children’s Endocrinology program has posted new algorithms for goiter, hypothyroid, obesity, short stature and vitamin D deficiency on its Refer a Patient page webpage, along with related resources for these conditions. The tools help PCPs know how and when to manage their patients’ endocrinology care in the primary care setting.

Seattle Children’s recently announced updated referral requirements for several specialties, including Endocrinology and Diabetes, Genetics and Gastroenterology, as well as a major change in the Diabetes intake and patient education protocol. Otherwise, healthy diabetes patients ages five and up will now be referred to a two-day outpatient education program rather than the previously prescribed two- to three-day inpatient hospital stay, as long as they meet the eligibility requirements. Details are available on our Endocrinology and Diabetes Refer a Patient page under “Patients newly diagnosed with diabetes.” Read full post »

Diagnosing and Treating Thyroid Cancer: A Q&A With Drs. Scott Manning and John Dahl, with Case Study

Headshot of Scott Manning

Scott Manning

Headshot of John Dahl

John Dahl

Is thyroid cancer on the rise?

Scott Manning, MD, program director, Otolarnygology Education, and John Dahl, MD, PhD, MBA, pediatric otolaryngologist, Seattle Children’s: Yes, the reported incidence of thyroid nodules across all age groups is increasing in the United States, with thyroid cancer now the fastest-growing cancer diagnosis for adult women. We believe environmental factors are contributing to this rise. For children, a thyroid nodule has an even higher chance of being malignant than for adults; in some centers, as many as 20% of pediatric thyroid nodules turn out to be cancer, versus 5 % in adults. That said, it’s important to keep in mind that the majority of thyroid nodules in children and adults turn out to be benign. About 350 pediatric thyroid cancers are reported each year in the United States.

What is the best way to diagnose a thyroid nodule?

Ultrasound is the best way to initially evaluate a nodule and will determine whether a particular nodule additionally needs a fine needle aspiration (FNA) biopsy in order to make the definitive diagnosis. Ultrasound does not require anesthesia/sedation or radiation and is cost-effective. It can also be used to evaluate for the presence of cervical metastases in children with thyroid cancer.

At Seattle Children’s, we are able to do FNA biopsies in clinic with our kids awake under local anesthetic, which makes the process that much safer and easier on the family and child. About 85% of our FNA biopsies are done this way, which is unique in the United States; most FNA biopsies elsewhere are done under general anesthesia.

It’s important to have a patient’s ultrasound read by a pediatric radiologist rather than an adult radiologist, because of their specialized knowledge and training in working with children and imaging.

For a variety of treatment-related reasons, we don’t recommend diagnosing a nodule by starting with a CT with contrast. Read full post »

CME: Pediatric Anxiety, Nov. 21

Headshot of Kathy Melman

Kathy Melman

Seattle Children’s Mood and Anxiety Program is presenting a Category II CME on pediatric anxiety, featuring Kathy Melman, PhD, clinical director of Outpatient Psychiatry & Behavioral Medicine.

Date: Thursday, Nov. 21, 2019, 6 p.m

Location: Providence St. Peter’s Hospital, Conference Room 200, 413 Lilly Road NE, Olympia, WA 98506

 

Objectives:

  • How to refer for anxiety treatment at Seattle Children’s
  • Identify the critical, active ingredient in behavioral treatment of anxiety disorders
  • Understand why it is critical for parents to be actively involved in CBT treatment of pediatric anxiety disorders
  • Describe the Stepped Care Model of Anxiety Treatment at Seattle Children’s
  • Learn about the effectiveness of group treatment for anxiety disorders
  • Where to find recommended resources on anxiety disorders to share with patients and families
  • Future updates/plans at regional clinics

 

Please RSVP by Nov. 18 to patricia.kilburn@seattlechildrens.org.

Read full post »

Seattle Children’s Verified as Level I Children’s Surgery Center

Seattle Children’s has been newly verified as a Level I Children’s Surgery Center by the American College of Surgeons (ACS). Seattle Children’s is the only children’s hospital in Washington, and one of only 21 in the United States, to achieve this highest level of certification for pediatric hospital surgical programs.

The Level I designation recognizes all surgical, procedural and many support programs and services at Seattle Children’s — more than 40 departments and programs in total — and represents a major accomplishment for all programs and services that interact with surgical patients.

The verification process was rigorous. Surveyors from ACS visited in March to review our surgery program’s structure, processes and clinical outcomes data in detail. Surveyors were impressed with many aspects of Seattle Children’s surgical programs, particularly the quality improvement programs and collaborative, multidisciplinary care. Read full post »

Renovated Clinic Re-opens as “Sand Point Clinic”

Seattle Children’s newly renovated Sand Point Clinic (formerly the Hartmann building, located immediately across the street from the hospital building) re-opened Oct. 23. The exterior of the building looks much the same, but the interior has been completely reconstructed to modernize the mechanical systems, improve the building’s efficiency and accommodate new clinical and administrative space.

Orthotics and Prosthetics, which used the building prior to renovation, has already moved back in and resumed seeing patients. The Endocrinology and Diabetes program will move in the first week of January. The building is better configured for the program’s new focus on providing education to newly diagnosed diabetes patients whenever possible in an outpatient setting rather than inpatient setting. Seattle Children’s has also updated its referral instructions for referring providers for the Diabetes program to require additional lab/test results before referring a newly diagnosed diabetes patient. Read full post »

New Clinical Pathway for Musculoskeletal Infections

Seattle Children’s has developed a new Musculoskeletal Infections Pathway. The purpose of the pathway is to develop and standardize an evidence-based approach for the evaluation and care of patients with musculoskeletal infections, including septic arthritis and osteomyelitis.

Pathway Recommendations:

  1. Order CBC with differential, CRP and ESR for all patients undergoing diagnostic evaluation for septic arthritis and/or osteomyelitis.
  2. Order two blood cultures (aerobic + anaerobic) for all patients undergoing diagnostic evaluation for septic arthritis and/or osteomyelitis with moderate/high likelihood of disease. Consider ordering two blood cultures (aerobic + anaerobic) for all patients undergoing diagnostic evaluation for osteomyelitis with low likelihood of disease. Blood cultures (aerobic + anaerobic) should be drawn prior to initiating antibiotics for patients with confirmed musculoskeletal infections.
  3. Order X-ray of the suspected involved bone(s)/joint(s) for all patients undergoing diagnostic evaluation for septic arthritis and/or osteomyelitis.
  4. Order ultrasound of the suspected involved joint(s) for all patients undergoing diagnostic evaluation for septic arthritis, particularly ultrasound of the hip in any patient at risk for septic arthritis of the hip joint.
  5. Empiric first-dose antibiotics for septic arthritis and/or osteomyelitis should include:
    a) Nontoxic; low risk for MRSA: cefazolin 50 mg/kg IV × 1 (max dose: 2000 mg)
    b) Nontoxic; cefazolin allergy or MRSA risk factors present: clindamycin 13.3 mg/kg IV × 1 (max dose: 600 mg)
    c) Systemically/critically ill and MRSA not yet ruled out by culture: vancomycin 15 mg/kg IV × 1 (max dose: 2000 mg)

Read full post »

Seattle Children’s Opens Building Cure

Seattle Children’s almost doubled the size of its downtown Seattle pediatric research campus with the opening last month of a new 12-story, $300 million facility at Terry Avenue and Stewart Street in Seattle’s biotech corridor. Building Cure houses 10 floors of new biomedical laboratory space, including “the Cure Factory,” capable of manufacturing cell-based therapies to treat up to 1,000 children per year.  It includes a 255-seat amphitheater and Science Discovery Lab to support STEM education programs for children and teens.

 

Read Seattle Children’s press release.

Read more from GeekWire. Read full post »