Dozens of critically ill patients at the Virginia Mason Medical Centre in Seattle have been infected by a drug-resistant bacteria known as CRE after undergoing  endoscopic procedures involving specialized duodenoscopes. Although local and federal health officials did not identify any deficiencies in their infection control practices, the hospital has worked to enhance their protocol for cleaning and disinfecting these scopes and have increased their scope inventory which allows them to have more time between procedures to ensure that each scope is properly cleaned. 

The mortality rate for this type of bacterial infection can be as high as 50%, yet neither infected patients nor their families are being notified. Health officials state that there is little that these very sick people can do in response to this information, and according to the Virginia Mason Hospital, there is no sense in fostering fear in the public. Infection-control expert Lawrence F. Muscarella is concerned that patients are contracting this dangerous bacteria because of the design of the duodenoscopes. Muscarella's concern is that even when a hospital adheres to the recommended cleaning and disinfection guidelines, the endoscopes may continue to harbour bacteria. 

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CRE bacterial outbreaks are leading to patient deaths after transmitting an infection from an endoscopic procedure (ECRP). An ECRP is a procedure that most often involves a duodenoscope being threaded down a patient's throat. This specialized endoscope allows endoscopists to diagnose and treat issues in a patient's GI system without the invasiveness of a surgical procedure. The benefits of these procedures far outweigh the harm, however, because of the complex nature of these endoscopes, there are small passages and channels that are extremely difficult to clean and disinfect. 

Recently, a bacterial outbreak in Seattle, which was linked to the death of 7 patients, is attributed to contaminated duodenoscopes. It has been confirmed that in five of these cases, patients were contaminated with CRE (Carbapenem-Resistant Enterobacteriaceae), a bug that is resistant to most antibiotics. 

Although several CRE outbreaks in the US have been traced back to duodenoscopes that have not been properly disinfected, neither endoscope manufacturer's nor the FDA have established guidelines for reprocessing the special channels of these scopes. Some physicians have taken this issue into their own hands by developing protocols for adequately disinfecting duodenoscopes. Currently, regulatory bodies continue to recommend that adhering to the reprocessing guidelines of endoscope manufacturers as well as federal reprocessing guidelines to minimize the risk of infection.

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During Fall 2013, 45 year old Kim Smith died after developing necrotizing fasciitis (flesh-eating disease) which resulted from an infection contracted during a routine surgery at a Canadian hospital. Although this particular case has made headlines, a large portion are not reported. Many provinces in Canada do not have the regulations in place which require hospitals to report these life threatening bugs, leaving Canadians in the dark. Although there is a debate about whether reporting these instances can improve healthcare, it is clear that having documented procedures for disinfection and sterilization can have a large impact on minimizing the amount of surgical infections in our hospitals.

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It has been recently reported that 35 patients from a Calgary hospital could have been exposed to HIV and/or Hepatitis due to endoscope reprocessing failures. Although the hospital has infection control protocols in place, small parts went missing from four washer/disinfectors. The risk to patients is fairly low, however it is concerning because the missing parts could have potentially  impacted the cleaning and disinfection efficacy of the machines. In this case, a machine with self-monitoring capabilities may have prevented this situation by detecting an error that was overlooked in manual checks and inspections. By combining self-monitoring technology with manual checks, the risk of infection can be significantly reduced. To read the full news article on this story, click here.