Carbapenem-resistant Enterobacteriaceae, a family of bacteria, also known as CRE, infected seven patients who had endoscopic procedures done at the Ronald Reagan UCLA Medical Center. Two of those seven patients died, and the infection was a contributing factor. Classified as a healthcare-associated infection (HAI) by the Centers for Disease Control and Prevention (CDC), CRE bacteria is particularly dangerous because it has high levels of resistance to almost all antibiotics. A study published by the Infection Control and Hospital Epidemiology journal reports that CRE can kill up to 50% of infected patients.
CRE primarily infects patients in acute and long-term healthcare settings. CRE bacteria can cause infections by entering the body through medical devices. Nearly every state in the U.S. has had a reported case of CRE in the past. At Seattle’s Virginia Mason Hospital, 32 patients had CRE bacterial infections and 11 of those died between November 2012 and March 2014. Thirty-eight cases of CRE infections were reported by Chicago’s Advocate Lutheran General Hospital in 2013 out of the 243 patients who may have been in contact with the bug during endoscopic procedures.
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In the case of the CRE outbreak at UCLA, infected patients had undergone a procedure using a specialized endoscope to diagnose and treat pancreaticobiliary diseases, including problems with the pancreatic and bile ducts. 500,000 patients each year in the U.S. undergo this endoscopic retrograde cholanglopancreatography (ERCP) procedure. After the ERCP procedure, the endoscopes were routinely cleaned using the protocol recommended by the scope manufacturer. Although this protocol provides sterilization against other bacteria and viruses, public health officials have determined that the devices remained contaminated with CRE and that the standard cleaning process was insufficient against preventing CRE. As a precautionary measure, UCLA has contacted 179 patients who underwent any endoscopic procedures to diagnose and treat disease of the liver, bile ducts, and pancreas at the hospital between October 3, 2014 and January 28, 2015. The patients have also been offered free home testing kits to be analyzed by UCLA.
Officials from the Food and Drug Administration (FDA) have issued a warning that the design of duodenoscopes used in ERCP procedures may impede effective cleaning and meticulously cleaning duodenoscopes prior to high-level disinfection should reduce the risk of transmitting infection, but may not entirely eliminate it.
While UCLA followed the national guidelines and the sterilization protocol by Olympus Medical Systems Group, the endoscope’s manufacturer, for cleaning the endoscopes, UCLA has also taken additional steps to avoid future CRE outbreaks. The endoscopes are now being outsourced for further gas sterilization and UCLA is working with the LA County of Public Health to take cultures from the scopes to ensure complete CRE eradication from each scope.
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