CRE outbreak: You're due to go in for a procedure. Should you be worried? - CNN.com

UCLA narrows cause of superbug infection to 2 tools 01:15

(CNN)You're due to go in for a medical procedure. But after what happened at a UCLA hospital, you're a little apprehensive.

Two
patients died at the Ronald Reagan UCLA Medical Center in a superbug
CRE outbreak, caused by two medical scopes that still carried the
bacteria even after they were disinfected.

In addition to the two
victims, seven hospital patients were infected with the deadly superbug
between October and January. The medical center has contacted 179
others who had endoscopic procedures between October and January and is
offering them home tests to screen for the bacteria.

The superbug, carbapenem-resistant Enterobacteriaceae, or CRE, can kill up to half the patients who contract them, the Centers for Disease Control and Prevention says.

So, should you cancel your procedure?

Here's what you need to know:

1. What type of equipment caused these horrible infections?

They're called duodenoscopes.

The
UCLA hospital was using a duodenoscope made by Olympus Corp. of the
Americas, but the Food and Drug Administration is also reviewing data
from the two other U.S. companies that make the devices, Fujifilm USA
and Pentax Medical.

Duodenoscopes are most commonly used for
procedures on the gallbladder, pancreatic ducts, and the bile ducts,
which are a series of thin tubes that reach from the liver to the small
intestine.

2. I'm scheduled to get a colonoscopy soon. Should I be worried?

No. Duodenoscopes are not used for colonoscopies.

3. How common are these infections, and why do they happen?

More
than half a million duodenoscope procedures are done every year in the
United States, and there have been fewer than 100 known cases of
transmission of the CRE bacteria, according to the American Society for Gastrointestinal Endoscopy.

The problem is this: A part of the scope called "the elevator" can be tough to clean because it has many small moving parts.

According to the FDA, the cleaning instructions that come with duodenoscopes say to brush the elevator area -- but that might not be enough.

"The
moving parts of the elevator mechanism contain microscopic crevices
that may not be reached with a brush," the FDA said Thursday. "Residual
body fluids and organic debris may remain in these crevices after
cleaning and disinfection. If these fluids contain microbial
contamination, subsequent patients may be exposed to serious
infections."

4. Yech. I'm supposed to have a procedure with a duodenoscope. Should I cancel it?

No.
A procedure with a duodenoscope can be lifesaving. It can remove
gallstones, for example, or insert a stent into a blocked bile duct. If
you need it, you need it.

5. OK. My doctor says I need it. So how do I make sure I'm safe?

Remind your doctor that following the manufacturer's cleaning instructions on a duodenoscope might not be enough.

Show your doctor this advisory from the FDA
that recommends additional cleaning practices, including meticulously
cleaning the elevator mechanism by hand. Many hospitals already do this.


Also, show your doctor this article from the Centers for Disease Control:
A hospital in Illinois put a stop to duodenoscope infections by using a
technique called gas sterilization. Other hospitals have started
testing their scopes for bacteria and only using them when the results
come back negative.

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