Dirty Endoscopic Surgical Tools May Be Linked to Infections Reports in NC, Similar to UCLA

Amid concern over a risk of deadly “superbug” infections linked to improperly cleaned endoscopes at UCLA Medical Center in California, health care professionals in North Carolina warn that a similar outbreak of antibiotic-resistant bacteria has killed at least two patients and sickened 18 others on the other side of the country.

The Carolinas Healthcare System reports that the patients have contracted carbapenem-resistant Enterobacteriaceae (CRE) this year after stays in the hospital. At least three of the cases appear to be hospital-acquired infections, however some appear to have been contracted outside of the hospital. At least two of the patients have died

The new warning comes one week after nearly 180 California patients were warned that dirty endoscopic surgical tools used between October 2014 and January 2015 may be the cause of a CRE infection outbreak at UCLA Ronald Reagan Medical Center, in which at least seven confirmed cases have been identified, including two deaths.

The incidents have led to questions over the recommended sterilization procedures for a form of endoscope, known as a duodenoscope, which is used in hundreds of thousands of endoscopic retrograde cholangiopancreatography (ERCP) surgeries each year.

The FDA issued warnings last week, which suggested that blood and other contaminants can become trapped, even when the endoscope is cleaned according to manufacturer instructions.

Not only does carbapenem-resistant enterobacteriaceae (CRE) resist treatments by antibiotics, but it kills about half of those it infects, leading the U.S. Centers for Disease Control and Prevention (CDC) to refer to it as a “nightmare bacteria”.

It is unclear whether the North Carolina illnesses are linked to similar devices and problems. While Carolinas Healthcare System officials have reported that all duodenoscopes there have tested negative for CRE and that they were cleaned according to standard disinfection methods, they have not specifically said that the patients underwent procedures involving duodenoscopes or other endoscopes.

However, according to the FDA safety communication issued last week, duodenoscopes may have designs that make them difficult to clean properly even when doctors and health care professionals follow the recommended steps for cleaning it. Many of the devices include a movable “elevator” at the tip, which may trap pathogens and blood even when recommended cleaning techniques are used.

Duodenoscopes are flexible, lit tubes that are inserted down the throat to the top of the small intestines for gastrointestinal procedures. They allow contrast dye to be injected and can be used with other medical instruments to retrieve biopsy samples.

At least one endoscopy infection lawsuit has already been filed over the UCLA outbreak, which has raised questions over the cleanliness of numerous medical devices, which have become more complex and more difficult to clean in recent years.