Hospitals Testing Cleaning Methods for Scopes Linked to Outbreaks

U.S. hospitals are still working to determine the best method to disinfect the medical endoscopes that have been linked to a superbug outbreak at two California hospitals this year, the Los Angeles Times reports (Terhune/Petersen, Los Angeles Times, 5/14).

Background

As many as 179 patients could have been exposed to Carbapenem-Resistant Enterobacteriaceae after having an endoscopic retrograde cholangiopancreatography at UCLA's Ronald Reagan Medical Center between October 2014 and January 2015. So far, seven patients have been confirmed to have CRE infections, and two of those patients died.

Meanwhile, Cedars-Sinai Medical Center in Los Angeles in March reported that four patients had been infected with CRE and up to 67 more might have been exposed after being treated with the same type of scope, called a duodenoscope.

Device manufacturer Olympus American issued updated guidance on how to disinfect the scopes calling for:

• Additional flushing to remove debris from the devices' crevices; and
• Using a smaller cleaning brush.

Olympus started sending out the brushes this month.

FDA said the scopes can be adequately cleaned with "high-level disinfection" if hospitals follow the new instructions (California Healthline, 3/27).

Details of Hospital Efforts

However, hospitals still lack clear guidance from health officials on the most effective way to clean the devices, according to the Times.

As a result, many have started testing various cleaning methods, including:

• Hand-washing the scopes before putting them in an automated reprocessing machine;
• Repeating the hand-wash and automated disinfection cycle twice;
• Testing a 48-hour surveillance system in which cleaned scopes are cultured for any bacterial growth before they are used again; and
• Using standard cleaning measures and gas sterilization (Los Angeles Times, 5/14).

Seattle Hospital Joins Lawsuit

In related news, Seattle-based Virginia Mason Medical Center -- where 39 patients were sickened by the scopes -- has joined a lawsuit against Olympus claiming that the devicemaker put patients at risk by failing to disclose design flaws in its endoscopes, the Los Angeles Times reports.

In March, Theresa Bigler, the wife of a patient who died at VMMC, filed the lawsuit against Olympus, alleging the scopes were the cause of her husband's death (Terhune, Los Angeles Times, 5/12).

Andrew Ross, the head of gastroenterology at VMMC, said the hospital was misled about the risk to patients.

He said, "Olympus failed to inform our organization about this safety risk associated with its product," adding, "Their silence on this important issue was unethical, irresponsible and put patient lives at risk" (Cavaliere, Reuters, 5/12).

An Olympus spokesperson said, "We are continuing our investigation into the reports at Virginia Mason to be able to provide a more thorough and balanced perspective on the issues including potential causes of the infections" (Los Angeles Times, 5/12).