Devices & Diagnostics, Hospitals

Scopes may be to blame for the UCLA superbug infections, but drug-resistant bacteria is the real enemy

Since the news of the CRE (carbapenem-resistant enterobacteriaceae) infections at UCLA’s Ronald Reagan Medical Center […]

Since the news of the CRE (carbapenem-resistant enterobacteriaceae) infections at UCLA’s Ronald Reagan Medical Center on Wednesday, many are concerned about how the design of the duodenoscope used is difficult to sterilize.

Seven people were infected with CRE and two have died. The device is often used to do procedures on the gallbladder, pancreatic ducts and the bile ducts, and the design is different than endoscopes used for colonoscopies or to examine the esophagus.

As The LA Times describes the device, it “has a side-mounted video camera and a small ‘elevator’ designed to steer fine-scale instruments at oblique angles into tiny ducts.”

“There’s a little pocket behind the elevator that’s a potential site for contamination to reside,” Dr. Bret Petersen, a professor of medicine at the Mayo Clinic in Rochester, Minn., told The Times. He led a 2011 effort to establish guidelines for disinfecting the instruments with the American Society for Gastrointestinal Endoscopy.

On Thursday, the Food and Drug Administration issued a warning stating that this kind of device is extremely difficult to fully clean and could lead to risks of bacterial infection.

Judy Stone explains the general cleaning procedure in Forbes: “Scopes usually undergo ‘high-level disinfection’ between patients, where they are cleaned by hand to remove any visible debris, and then soaked for 20 minutes in 2% glutaraldehyde, a toxic chemical which kills most bacteria, fungi, and viruses.”

After this outbreak, UCLA has switched from the “high-level disinfection” method for the Olympus scopes used to the much pricier ethylene oxide (EtO) sterilization procedure, which will require the hospital to buy more scopes because the procedure takes 12 hours.

As Stone points out in her article, although effective disinfecting procedures are crucial, the fear shouldn’t be of the devices necessarily, considering the incidence of infection associated with endoscopes is only about 1 in 1.8 million procedures. What’s really scary and deserves more attention is the increasing presence of antibiotic-resistant bacteria.

She writes:

The UCLA outbreak, and the worse one with the newly reported colistin resistance in Pittsburgh are signs that we are approaching the end of the era of antibiotics. There are numerous reasons for this ranging from physicians not wanting restrictions on their prescribing patterns, to pharma’s detailing drugs irresponsibly, to our seeming current belief that there will always be a new “miracle drug” just around the corner, to the misuse of antibiotics in agriculture to the ready availability of antibiotics “over-the-counter’ without prescription in many countries. The bottom line is that it appears that we are all too rapidly headed back to the pre-antibiotic era, when even a minor scratch could be a death sentence.

[Photo from Flickr user Minuk]

Shares0
Shares0