Tough-to-Clean Equipment a Bigger Problem

The number of deaths attributable to certain medical probes may go beyond a recent outbreak in Los Angeles.

By Kerry Grens | March 2, 2015

WIKIMEDIA, NATHAN READINGA recent outbreak in California of drug-resistant bacteria tied to contaminated endoscopy instruments is helping to bring to light similar outbreaks in other states, according to a report in Bloomberg Business. The bacteria involved are called called Carbapenem-resistant Enterobacteriaceae (CRE).

For instance, six years ago, 15 patients died and another 70 were sickened in Florida in an outbreak similar to the one that occurred at the UCLA Medical Center in recent months. Other “superbug” cases occurred in Pennsylvania, Illinois, and Wisconsin in the past few years—each of which was tied to exposure to a certain type of endoscope and which was not made public, according Bloomberg.

“States have a haphazard approach to tracking the infections,” the news organization reported. “Only about half of the 44 state health departments that responded to questions from Bloomberg said they require hospitals and labs to report individual cases of CRE.”

“I am speechless when it comes to this,” Lawrence Muscarella, the president of LFM Healthcare Solutions, who tracks endoscope re-use issues, told Al Jazeera America. “When a medical device or drug is being used is harming people and it’s risen to the level that it has today, action needs to be done. Ideally, action should have been done yesterday. It should have been done two years ago. I can’t explain to you why it hasn’t been done.”

Cleaning procedures for the medical devices are coming under review, and the US Food and Drug Administration has issued a safety alert regarding the devices, called duodenoscopes.

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Avatar of: Nemo


Posts: 4

March 3, 2015

The problem lies in cut backs to CSR departments and the low pay of workers sterilizing equipment. Would you let someone making minimum wage sterilze surgical equipment? I wouldn't trust them to make my burger properly.

Avatar of: Dr Edo

Dr Edo

Posts: 30

March 3, 2015

Nemo--is very correct but this issue goes much deeper. The State of California tests and licenses people in various aspects of dealing with public health related to control of bacteria. Those issuing licenses and the tests may themselves have little back ground or capacity in these areas and those doing the work are, as Nemo notes, poorly trained, if trained at all. Thus the system can not correct what it has refused to know. With respect to the above, I am discussing amongst other confounders to the growing problems with spreading antimicrobial resistant microbes, the local sewer plant. The sewer plant is a key area where these organisms are produced in industrial volumes to later be dumped into our rivers and sources of drinking water.

The endoscopes are to receive high-level disinfection, and that is failing. But think about systems that use low-level disinfection (mesophilic temperatures) and systems that are receiving pathogen requiring high-level disinfection requiring organisms from hospitals. These organisms are loaded into wastewater sent from hospitals to sewer plants. Here we need to focus primarily on sewer plants that are down stream from hospitals. If high-level disinfection is not working at the hospital level and sewer plants receive abundant numbers and varieties of resistant organisms which are mixed during sewage treatment, this sees high levels of gene exchange.

Then based on that, those running such plants would, one assumes, be highly trained. In fact, there are no requirements in this area.  A primary production source for antibiotic resistance is the local sewer plant. Bacteria that in nature might never meet are thrust into an environment encouraging gene exchange and then released. You may well ask about chlorine disinfection. For example, MRSA, when exposure to chlorine, actually up regulates virulence genes. The free circulating genes are little affected by chlorine as used in the wastewater industry. The same for UV. The filters and screens do not stop the flow-through of genes unless we get to screens down at levels capable of retaining something of about 9nm. These resistant organisms and their genes are thus found in effluent dumped into the ocean or in recycled water going onto school yards and community parks.

A question needing answers is one of discharged bacteria and genes getting into people and then recycled back into the hospital. Is this issue being studied by those doing the regulations or developing training requirements? The answer seems to be no. Nonetheless this issue has been known about for some time and the regulatory community just turns a blind eye.  Actually, this blind eye approach seems to be standard procedure for the regulatory community. It has known about this issue for at least three decades. Don't expect much other than post hoc rationalizations for missed opportunities. Be surprised if actual policy comes from this. It will be politically swept under the carpet and arise again for the same reasons.

Dr Edo McGowan


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