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.

For the 6th year in a row, the ECRI Institute has included Inadequate Reprocessing of Endoscopes and Surgical Instruments on its list of the Top 10 Health Technology Hazards. This year Inadequate Reprocessing lands at #4 on the list moving up from #6 in 2014. To see the complete list of the Top 10 Health Technology Hazards for 2015, visit the ECRI Website.

Numerous surgeries were cancelled last week at the Chinook Regional Hospital in Lethbridge, Alberta after finding residue on surgical instruments. Until the problem is resolved, equipment is being sent to other Alberta Health Services facilities for reprocessing. 

In the past year the auditor general has identified concerns over the reprocessing of medical devices at healthcare facilities within the province emphasizing the importance of proper reprocessing of equipment for patient safety. Additionally, the auditor general notes that in order to consistently and properly reprocess medical devices a system must be established to oversee and direct the province's facilities.

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In October, ARC attended the CAMDR 2014 Conference where Dr. Michelle Alfa, (Professor at the University of Manitoba and Principal Investigator at the St. Boniface Research Centre) spoke about Medical Device Reprocessing, and specifically how we can 'ban the biofilm'. In her presentation, Dr. Alfa emphasizes the importance of the cleaning stage for preventing the buildup of fixed materials on instruments. In order to improve channel cleaning, she recommends automating and verifying the cleaning cycle as well as dry storage for flexible endoscopes. To find out more about how bacterial transmission through flexible endoscopes can be prevented, read the presentation handout below.

If you're interested in viewing handouts for the other conference presentations, click here to visit the CAMDR website.

A patient of a Chicago area hospital is filing a lawsuit claiming that she, along with 43 other patients, contracted a bacterial infection from an improperly cleaned endoscope. The CDC (Centers for Disease Control and Prevention) has confirmed 38 cases of exposure to CRE bacteria from this particular hospital. CRE bacteria is naturally found as part of human gut bacteria however, according to the CDC, this type of bacterial infection can be difficult to treat and can contribute to death in up to 50% of patients who become infected. Cases like these emphasize the importance for robust endoscope reprocessing practices in Hospitals and Clinics as a way to preserve patient safety.

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On top of following standardized endoscope reprocessing protocols; there are a number of other steps that can be taken to improve both patient and technician safety while continuing to efficiently reprocess scopes in a high volume environment. 

OutpatientSurgery.net recently posted an article listing '7 Steps to Safer Endoscope Reprocessing' outlining a number of practices that can be implemented in your healthcare facility. The article stresses the importance of removing blood and biofilm from scopes via manual cleaning to allow for effective disinfection in an AER. Additionally, it recommends using automated technology to provide consistency in the cleaning and disinfection processes, prevent technicians from removing scopes before required reprocessing times have been achieved, allow technicians to verify cycle efficacy, and provide notifications when chemistries require replacement/replenishment. The final step for improving safety involves segregating reprocessed endoscopes to prevent re-contamination and focusing on a safe transition between designated clean and contaminated areas.

By implementing some of the practices provided in this article, you can help to improve the safety and effectiveness of the reprocessing department in your healthcare facility.

Click here to read the full article on Outpatient Surgery.net...