NHS Lothian has contacted 186 patients who had heart aortic valve replacement operations at the Royal Infirmary of Edinburgh in the last six months to advise them of a possible infection risk.
The decision was taken by an Incident Management Team which was convened following notification of an unusual case of heart valve infection.
Heart valve infection is known as endocarditis.
The team conducted an extensive review of the infection records of thousands of patients who had many different types of surgery carried out since the beginning of 2015.
The team found that six patients who underwent cardio thoracic surgery over a period of 18 months were affected by unusual infections caused by micro organisms commonly found in the environment.
It is thought these may have been acquired during surgery. Of the small number of patients affected, sadly some later died.
No cases were found prior to March 2017 and there have been no known cases in patients operated on since November 2018.
As a precaution however, four planned surgeries have been cancelled this week to allow for specialist cleaning and disinfection of the theatres used for this type of procedure. Enhanced infection control measures have also been put in place.
READ MORE: Operations halted after infection hits Edinburgh hospital wardProf Alex McMahon, NHS Lothian Executive Lead for Infection Control said; “We extend our sincere apologies and deepest condolences to the families of the patients who died, all of whom were informed at the time of their treatment that they had an unusual and difficult to treat infection."
Commenting on the decision to contact all patients who have had this procedure over the last six months Prof, McMahon said: “We know this will be a worrying time for those who have received letters but we have contacted patients purely as a precaution.
"The risk is very low and we do not anticipate any more cases, however we know that it can take up to six months for these infections to materialise. We want to make sure those patients know what symptoms to be aware of and to contact NHS Inform if they have any concerns.
“Many patients receiving this type of surgery are already very ill and vulnerable to infection so we place the highest importance on a stringent infection prevention and control regime.
“We are very sorry for the inconvenience and disappointment caused to the patients who have had their procedures cancelled this week but we must prioritise patient safety above all else. "All those affected will be given new appointments as soon as possible.”
READ MORE: MSPs hear of communication failures at scandal-hit Glasgow hospitalA Scottish Government spokesperson said: “Our thoughts and condolences are with the families and friends of those patients who have sadly died. We know this will be a worrying time for those who have received letters, and while the risk of infection is low, it is important that they follow the advice given by NHS Lothian.
“NHS Lothian is undertaking specialist cleaning and disinfection of the theatres used for this type of procedure and have stated that enhanced infection control measures have also been put in place.
“Scottish Government officials remain in close contact with the health board on this incident.”
Endocarditis occurs in 0.5% of patients per year and can have many different causes - usually the source is the patient’s own body. These cases are unusual because the micro-organisms which have caused the endocarditis are more commonly found in the environment.
Medications similar to antibiotics are available to treat these infections but they can nonetheless be severe, particularly in patients who are already very ill or whose immune systems are compromised. NHS organisations have a statutory requirement to protect patient confidentiality and must adhere to Caldicott Principles.
These principles prevent NHS organisation from stipulating the exact number of cases if that number is equal to or fewer than five.
NHS Lothian has sent notification letters to 186 patients in connection with this risk.
The formation of a multi-disciplinary Incident Management Team is standard practice to investigate and ensure all necessary actions are taken. The team includes the involvement of Health Protection Scotland.
Scottish Labour's Shadow Cabinet Secretary for Health, Monica Lennon MSP, said: "This will be a cause of concern for people in NHS Lothian and across the country.
"The health board have made the right decision in taking these precautions but this revelation again raises questions about infection control in hospitals across Scotland."
Tory health spokesperson Miles Briggs said: “My deepest sympathies are with the families of the patients who have died from contracting this infection.
“This has been the latest in a string of catastrophic failures of infection control in Scotland’s hospitals.
“It is of vital importance that processes in the Healthcare environment are reviewed and improved, to minimise the risk of infection in our hospitals.
“This will be a deeply distressing time for the 186 patients who have been notified by NHS Lothian that they are at risk of infection and all measures must be taken to ensure they are infection free.”