Healthcare News & Insights

Tool linked to superbug outbreak in hospitals

After local officials noticed a cluster of cases of carbapenem-resistant Enterobacteriaceae (CRE) infections in hospitals, they investigated the source. And in each case, the disease had the same origin: contaminated duodenoscopes.

hand with glove  is cleaning hospita equipmentThe epidemic began in 2012, according to an article in USA Today. Hospitals in various cities, including Seattle and Chicago, were seeing a dramatic rise in cases of CRE, a family of germs that’s almost immune to common antibiotics.

Once infected with CRE, patients have a tough time recovering. In fact, almost 40% of those who become sickened by the superbug die.

Why it happened

Dudodenoscopes are a special type of endoscope used by hospitals to treat various digestive disorders, including gallstones and certain types of cancer.

At each facility, clinicians had sterilized the duodenoscopes using standard protocol. However, investigation uncovered that, even after conventional cleaning methods, the scopes still retained bacteria.

Reason: The intricate devices have a number of pieces that are hard to disinfect with normal cleaning procedures.

Because of this, duodenoscopes have been linked to at least six outbreaks of CRE in hospitals over the past three years – some of which involved dozens of patients and several deaths.

Feds’ response

Although the superbug infection has brought the issue to light, the scopes could be even bigger contributors to hospital-acquired infections. Since they’re so difficult to disinfect, other common bacteria may be lingering inside them and making patients ill.

According to USA Today, the Food & Drug Administration (FDA) is aware of the problem, and it’s currently looking at whether new guidelines should be in place for disinfecting duodenoscopes, or if the scopes should be redesigned.

In the meantime, the FDA says that the benefits of the instruments far outweigh the risks, so facilities should continue using them for procedures.

What hospitals did

Some hospitals that experienced superbug outbreaks don’t think that’s enough. They’ve taken things into their own hands, changing their disinfection procedures for duodenoscopes to minimize the risk of bacteria making patients ill.

For example, at Virginia Mason Medical Center in Seattle, duodenoscopes are now quarantined and tested for residual bacteria after they’re cleaned. And several other hospitals are using a more complex cleaning process: EtO gas sterilization, which kills any remaining bacteria after conventional cleaning methods are used.

Both approaches were fairly costly for the hospitals, requiring extra staff, equipment and facilities. But since they’ve implemented the procedures, none of the hospitals have had any infections that could be traced to duodenoscopes.

Preventive measures

For facilities that don’t have the funding to make these changes to their disinfection process, there are other, simpler ways to cut back on infections caused by duodenoscopes.

One crucial step cited by several infection control experts: Conduct periodic testing by taking bacterial cultures from scopes. This will demonstrate whether a facility’s cleaning process for the instruments is effective and help determine whether changes should be made.

The FDA plans to release additional guidance about duodenoscopes and infection risks at some point this year, according to USA Today. We’ll keep you posted.

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