Letter that is being sent to patients

November 23, 2016

FNAME LNAME
PATIENT ADDRESS
Dear Patient (will be individually addressed)

We write today with some information about your recent care with us. There
is no specific action suggested for you and we believe there to be no cause
for concern; we are advising you because Vancouver Coastal Health is
committed to quality and safety and to being transparent.

You had a procedure at Lions Gate Hospital on PROCEDUREDATE, which

would have involved use of some instruments that are reprocessed, which
means they are washed and sterilized between uses. We have recently
learned that there was an unexpected change from our routine approach in
reprocessing of instruments for a short period of time.

Between November 10th 14th, four of the five pumps normally supplying
detergent to the machines known as washer/ disinfectors at Lions Gate
Hospital were not consistently receiving power and therefore not known to
be working as they normally would. However, the rest of the process took
place as usual. Instruments were taken apart, prewashed in a detergent
solution and then the washer/ disinfector. All instruments were mechanically
washed - a step that normally involves detergent but for these few days may
not have involved detergent - followed by a stage of thermal disinfection
(that is, involving high heat). The rest of the reprocessing continued as usual
including visual inspection, packaging, and finally sterilizing at a very high
heat.

While this uncertainty in consistent supply of detergent was unfortunate, we

believe it does not pose any relevant risk to patients. The risk is so low in
fact that our expert physicians do not recommend any action for you. We
share this with you only in the spirit of full disclosure.
Vancouver Coastal Health apologizes for this unexpected and unplanned
change from the usual process. We have reinforced procedures to confirm
each day that the detergent pumps are working. We have advised your
surgeon who will be working with you though your recovery.

We sincerely apologize for any inconvenience or concern this situation may

cause.

If you or your physician have any questions or concerns and wish to speak
with someone, please feel free to contact the VCH Patient Care Quality Office
at toll-free 1-877-993-9199, pressing 4 at the prompt, by email pcqo@vch.ca
or by fax 1-888-865-2941.

Thank you for your understanding.

Sincerely,

Karin Olson
Chief Operating Officer
Coastal Community of Care

Dr. Peter Edmunds

Dr. Ross Brown

Co-Senior Medical Director
Coastal Community of Care

Dr. Ramesh Sahjpaul

Co-Senior Medical Director

Coastal Community of Care

Medical Director, Surgery Program

Lions Gate Hospital