Becker's Hospital Review

16 INFECTION CONTROL & PATIENT SAFETY 1st death from a fecal transplant was at Massachusetts General Hospital By Gabrielle Masson T he first death from a fecal transplant occurred during a clinical trial run by Boston-based Massachusetts General Hospital, according to a paper published Oct. 30 in e New England Journal of Medicine. e 73-year-old man who died in spring 2019 had a rare blood condition and was a participant in a clinical trial at the teaching hospital. His death has been attributed to a rare type of bacteria that causes E. coli, found in fecal transplant materials he received. e fecal transplant capsules he was given were produced by the hospital in November 2018, with all fecal materials sourced from one stool donor. Massachusetts General Hospital scientists started screening for E. coli and other similar bacteria in January 2019, but did not test capsules they had already produced. "We didn't think of it. The prevalence of these organisms in healthy individuals is so low," Elizabeth Hohmann, MD, an author of the paper and infectious disease specialist at the hospital's lab that made the capsules, told STAT. She added that, in retrospect, it was obvious all capsules should have been tested. Capsules made of material from the same donor were given to 21 other individuals, according to the paper cited by STAT. One other person experienced serious side effects but recovered. Multiple subjects tested positive for the bacteria but were not sickened. e stool donor, dubbed donor No. 46, is healthy and didn't require treatment. Because of this, donor No. 46 was not informed about the incidents associated with her stool, a hospital spokesperson told STAT. n No disinfectant can fully eradicate C. diff, study finds By Gabrielle Masson N o hospital-grade disinfectant can totally eliminate Clostridioides difficile, although some are more effective than others, according to a study published in Antimicrobial Agents and Chemotherapy. Researchers analyzed five different C. difficile strains embedded within three types of biofilms grown for 72 or 120 hours. Each strain was exposed to seven different hospital disinfectants. No disinfectant completely eliminated C. difficile from the biofilms. Overall, Clo- rox, Cidex OPA and Virex were most effective at killing C. difficile spores. Clorox and Cidex OPA were also effective at killing total vegetative cell growth — the cellular mechanism that causes infections. Clorox and Virex most sucessfully decreased biomass, followed by Nixall, Cidex OPA and Vital oxide. n Newark Beth Israel put patients in 'immediate jeopardy,' CMS says By Gabrielle Masson N ewark (N.J.) Beth Israel Medical Center's heart and lung transplant program put patients in "immediate jeopardy," according to a Jan. 17 ProPublica report. The hospital's transplant program failed to fix mistakes numerous times, allowing "subsequent adverse events to occur," according to a pair of CMS reports sent to the hospital Dec. 12, 2019. Consequently, CMS determined that patients were in "immediate jeopardy." Over seven months, three patients suffered brain damage, according to the reports. CMS found no evidence that Newark Beth Israel reviewed these events for two of the patients. Then, starting in September 2018, the hospi- tal kept the third patient in a vegetative state alive for a year to improve its transplant program's survival rate. The reports also cited violations of patient rights, such as failing to obtain informed consent and seek information from patients and family on advance directives. Newark Beth Israel does not believe the "immediate jeopardy" was warrant- ed, hospital spokesperson Linda Kamateh said in a statement to ProPublica. Regarding the hospital's failure to correct mistakes, Ms. Kamateh said the CMS investigators lacked the "evidence, expertise and experience" to evalu- ate and diagnose patient outcomes. The hospital submitted policy changes Dec. 15, and the New Jersey Depart- ment of Health determined the measures sufficient, removing the "immedi- ate jeopardy" designation. The hospital was reviewing required correction plans before submitting them to CMS as of mid-January. Part of this plan includes a newly developed trans- plant steering committee to oversee the program, according to Ms. Kamateh. Newark Beth Israel was still not in compliance with federal rules for trans- plant centers as of Jan. 12, according to a CMS letter to the hospital cited by ProPublica. The hospital must regain compliance with all regulations by March 21 to maintain its Medicare funding. n

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