INFECTED bacteria from contaminated medical instruments is suspected in a “superbug” outbreak at the Ronald Reagan UCLA Medical Center that has infected at least seven patients, two of whom died. More than 170 others may have also been exposed to the antibiotic-resistant germs.
They were potentially infected with Carbapenem-Resistant Enterobacteriaceae, or CRE, during endoscopic procedures at the UCLA Medical Center in Los Angeles, between October 2014 and January, according to UCLA officials. Tests on an infected patient uncovered the outbreak, the latest in a string of similar health incidents nationwide.
Patients being alerted of the outbreak underwent “complex” endoscopic procedures in the four-month period. The notification number, as of Feb. 19, is at 180 potential at-risk patients.
“This bacteria is emerging in the US, and it’s associated with a high mortality rate,” Dr. Alex Kallen, an epidemiologist for the Centers for Disease Control and Prevention (CDC), told the Los Angeles Times. “We don’t want this circulating anywhere in the community.”
An internal investigation by UCLA determined that the bacteria “may have been transmitted during a procedure that uses a specialized scope to diagnose and treat pancreaticobiliary diseases,” such as gallstones, acute and chronic pancreatitis, and pancreatic cancer, and “may be a contributing factor in the death of two patients,” said UCLA Health Sciences spokeswoman Kim Irwin.
“[Medical personnel] sterilized the scopes according to the standards stipulated by the manufacturer. The two scopes involved in the infection each were immediately removed, and UCLA is now using a decontamination process that exceeds manufacturer and national standards.”
The two endoscopes involved are typically used to diagnose and treat pancreatic and bile duct problems, blocked by cancerous tumors, gallstones, or other conditions. A thin, flexible tube with a lit lens or miniature camera, the scopes are inserted into the body (usually through the mouth, throat, stomach, and into the top of the small intestine) to enable a doctor to view an organ or cavity without being invasive.
“We notified all patients who had this type of procedure, and we were using seven different scopes,” said UCLA spokeswoman Dale Tate. “Only two of them were found to be infected. In an abundance of caution, we notified everybody. We removed the infected instruments, and we have heightened the sterilization process.”
Patients who may have been exposed to the “superbug” are being offered free home-testing kits that can be analyzed at the university hospital.
CRE bacteria, a “family of germs,” are difficult to treat because some varieties are highly resistant to most known antibiotics. By one estimate, CRE can contribute to death in up to half of seriously infected patients, says the CDC. However, most health people usually do not get CRE infections.
In a previous news release, the CDC has said that some bacteria can kill up to half of all patients who become infected in their bloodstreams. The report added that almost all CRE infections “occur in people receiving significant medical care in hospitals, long-term acute care facilities, or nursing homes.” The most vulnerable people are hospital or nursing home patients, and those on ventilators using catheters.
“This is a nightmare bacteria,” said CDC director Dr. Tom Freiden. “Our strongest antibiotics don’t work and patients are left with potentially untreatable infections.”
On Thursday, Feb. 19 the US Food and Drug Administration issued an advisory warning doctors that even when a manufacturer’s cleaning instructions are followed, infectious germs may still be lingering in the devices. The endoscopes’ complex design and tiny parts make complete disinfection extremely difficult, the advisory said, making a hard-to-clean medical scope facilitate an increased risk of infection and the spread of such powerful “superbugs.”
The agency also said that even meticulous cleaning of the duodenoscopes, which are used on about 500,000 patients a year, may not entirely eliminate the risk.
Seventy-five medical device reports over the 2013-2014 year involved around 135 US patients who may have involved “microbial transmission” from scopes that had already been cleaned.
Lawrence Muscarella, a hospital safety consultant and expert on endoscopes in Montgomeryville, Pa., said the recent number of cases is “unprecedented.”
“These outbreaks at UCLA and other hospitals could collectively be the most significant instance of disease transmission ever linked to a contaminated reusable medical instrument,” he said.
Even before the CRE incident, UCLA has struggled at times with patient safety. An influential healthcare quality organization gave the Ronald Reagan Medical Center a failing grade on patient safety in 2012.
The hospital’s score improved to a C in the latest ratings from Leapfrog Group, a Washington-based nonprofit backed by leading medical experts.
Still, many doctors have expressed concern that the outbreaks might deter patients from seeking care they need.
“ERCP is a common and critical procedure in most hospitals today,” said Dr. Bret Petersen, a professor of medicine at Mayo Clinic’s division of gastroenterology and hepatology in Rochester, Minn. “It’s not a procedure we can allow to be constrained, so this is a serious issue we need to address.”
Similar outbreaks of potentially lethal CRE have been reported around the nation, from Seattle to Illinois, said the CDC. Since 2012, as many as 150 patients total have been affected by this type of bacteria, with over a half-dozen outbreaks nationwide. At least 47 states have already seen “superbug” cases, the CDC said.
(With reports from Los Angeles Times, AP, USA Today, NBC News)
(LA Weekend February 21-24, 2015 Sec. A pg.5)