CDC investigator discusses probe into 2008, 2009 fungal outbreak at Children's

13 year old Zachary Malik Tyler died of mucormycosis contracted at Children’s Hospital according to lawsuit. Photo provided by Zachary’s parents.
13 year old Zachary Malik Tyler died of mucormycosis contracted at Children’s Hospital according to lawsuit. Photo provided by Zachary’s parents.

A senior federal infectious disease investigator said there was no attempt to hide information about a deadly fungus that killed five children at Children's Hospital between 2008 and 2009. A study detailing the outbreak and deaths is only now being published in the May edition of Pediatrics Infectious Disease Journal.

When FOX 8 News reported on the issue Monday, many in the community - including veteran healthcare professionals - were surprised to hear about the outbreak of mucormycosis and outraged that the information had not been widely disseminated until now.

"Five patients acquired mucormycosis, and we think this mucormycosis was associated with linens," said Dr. Tom Chiller, who was a senior investigator during the Centers for Disease Control's investigation of the deaths at Children's. "We were able to work with the hospital to determine that linens were the source that was most likely, because of how we linked linens to these particular patients. And we were also able to find this particular fungus on the linens."

No source of the fungus was found in the hospital, according to the study.

"Without finding any point-source within the hospital, then it leads us to believe the source was actually was found outside," Chiller said.

He said the investigation also included the hospital's offsite linen services company.

"We didn't find problems with cleaning of the linens, or the way linens were being treated in our initial investigation," Chiller said. "We were focusing more on the patients - that's our expertise."

Throughout the study, Children's Hospital is referred to only as "Hospital A." When FOX 8 News reached out to Children's about the study, a spokesman confirmed that the facility was indeed Hospital A.

Chiller said not identifying a medical facility in such studies is not unusual.

"It's not that we are hiding that information in any way, shape or form - it's always publicly available - but that's just simply the rules with which we generally operate when talking about an outbreak. It helps keep the study portion objective," he said.

He was also asked why the findings are only now being published.

"Unfortunately, scientific journals and publications do take quite a bit of time, so in this particular case we were invited [by the state health department] in July 2009, performed the investigation, did a lot of the analysis and actually presented the results to infection control practitioners at a national meeting in 2010. So the results of the outbreak and the investigation were actually presented publicly, and that abstract and talk has been available online, I think since 2010, but then it's just a matter of getting all the final studies and results in place, and getting those into a paper," Chiller said.

The Louisiana Department of Health and Hospitals issued the following statement on why the general public was not informed of the outbreak:

"Investigations regarding infectious disease are a serious matter. In conducting these investigations, the Department must weigh the risks to the general public while protecting the privacy of families and patients. As those most at risk for mucormyscois are patients with significantly suppressed immune systems, the risk to the general population was very low in this situation. However, DHH did contact other hospitals to determine if similar problems were occurring.

"While Louisiana law does not require reporting of hospital-acquired infections (HAIs), the hospital in this case took the prudent step of reporting the situation to DHH because its own internal investigation identified several patients with the infection over an extended period of time in 2008 and 2009. Because we needed a lab with specialized capabilities we quickly included the CDC.

"DHH participates in statewide efforts to prevent infections, which we and the CDC find to be the most effective way to limit HAIs. We routinely communicate with infection prevention specialists throughout the state, including through discussions and presentations with hospitals, long-term care facilities and epidemiologists, among others. This communication is thorough and ongoing."

The five children who died ranged from 35 days to 13 years old. FOX 8 obtained a lawsuit filed by the parents of the 13-year-old boy who died after contracting the infection. The lawsuit was filed in May 2010 by the parents of Zachary Malik Tyler against Children's Hospital and TLC Services, Inc., which was the linen services company.

According to the lawsuit, Zachary entered the hospital in February 2009 and in March developed a black spot on his arm. The suit says that at one point, doctors recommended amputation of the teenager's left arm. Zachary died in May 2009.

"Only on May 5, 2010 did petitioners learn from a confidential source that in 2009 there was an outbreak of mucormycosis at Children's Hospital as a result of contaminated linens supplied by TLC Services, Inc., and that as a consequence of this outbreak five patients died, including Zachary Tyler," the lawsuit states.

Zachary's father was contacted for comment, but refused. His attorney, Harry Widmann, issued a statement which said:

"This is an ongoing matter. We are working to make sure that everyone responsible is held accountable. We may have more to say at a later date, but my clients and I have no comment at this time."

Children's Hospital released another statement on the infection and resulting deaths. It reads:

"Patient care and safety are hallmarks of Children's Hospital New Orleans (Children's Hospital).

"Upon recognizing the issue, Children's Hospital immediately responded and began an internal investigation. Following our appropriate protocols, and although not required, Children's Hospital immediately reached out to the CDC and the State Epidemiologist to assist in the investigation.

"Through proactive internal investigation, Children's Hospital identified a cluster of mucormycosis cases and immediately reported the situation to the CDC and the State Epidemiologist, despite not being required to do so.

"Protocol requires that CDC involvement must come at the request of the State Department of Health. Both entities were swiftly notified by Children's Hospital and both entities took part in the ongoing investigation at our invitation and request.

"Children's Hospital exceeded the recommended and required standard of response.

"The longstanding policy of Children's Hospital physicians is to notify family members of children that suffer complications or hospital associated infections. The families of living patients who became infected with mucormycosis were notified as soon as the illness was identified. Families and patients were kept informed throughout the process of diagnosis, treatment and investigation of the cause.

"Children's Hospital has revised its protocol as a result of internal findings with the validation of the CDC. Because mucormycosis is typically dangerous to those most vulnerable, Children's Hospital has rewritten our laundry protocol to address procurement of laundry services and in-house care, and treatment and storage of laundry to protect all of our patients. For the most at-risk patients, more aggressive standards have been put into place and include, but are not limited to, autoclave or dry sterilization of linens. These measures go beyond the industry standard for hospital linens, and have been carried out to this day.

"Children's Hospital granted permission to the CDC in October 2009, prior to the conclusion of the investigation, to share this information at an international conference in March 2010. Learnings were also distributed throughout national listservs and published in two laundry trade publications."

As for the deadly mucormycosis that found its way onto the hospital's linens and then onto patients' skin, Dr. Chiller said it remains a rare incident.

"Having them associated with linens is extremely rare, we have not seen another outbreak associated specifically, at that we know of, associated with linens since the outbreak in New Orleans," he said.

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