CEDAR RAPIDS — Outbreaks of a drug-resistant superbug in Chicago, Seattle and Pittsburgh have been linked to a specialized piece of medical equipment commonly used at Eastern Iowa hospitals.
Infection control experts believe germs, including the deadly CRE, or carbapenem-resistant Enterobacteriaceae, are passed from patient to patient on medical scopes, called duodenoscopes, with parts that are difficult to sanitize between uses.
About 10 percent of Iowa hospitals surveyed in 2014 reported seeing CRE, said Patricia Quinlisk, the state’s epidemiologist. But Corridor hospital officials said they’ve had no CRE cases, nor have they found infections from duodenoscopes used to diagnose and treat pancreatic disorders.
“Our cleaning strategies exceed the expectations of the (U.S. Food and Drug Administration) and the manufacturers,” said Dr. Theresa Brennan, chief medical officer for the University of Iowa Hospitals and Clinics.
Some in the U.S. medical community said the FDA and device manufacturers need to do more to keep patients safe. U.S. Sen. Patty Murray, D-Washington, asked the FDA last week to step up cleaning guidelines and track infections after seven people died from CRE infections linked to contaminated scopes at Virginia Mason Medical Center in Seattle, USA Today reported.
The Centers for Disease Control and Prevention in Atlanta identified nine other patients in northeastern Illinois who had positive cultures for the superbug from March through July 2013. Six of the eight treated at one hospital had treatment with a duodenoscope.
“Previous studies have shown an association between ERCP endoscopes and transmission of multidrug-resistant bacteria. The design of the ERCP endoscopes might pose a particular challenge for cleaning and disinfection,” the CDC reported Jan. 3.
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Duodenoscopes are used for endoscopic retrograde cholangiopancreatography, or ERCP, a procedure in which a scope is inserted down the throat, through the stomach and into the start of the small intestine. A thin catheter is passed from the end of the endoscope into bile ducts leading to the pancreas and gallbladder.
“These are extremely important procedures,” Brennan said. “The scopes open up blockages, do biopsies and collect samples for diagnosis.”
UIHC does about 2,000 ERCP procedures a year. Without the scopes, patients would have to undergo more invasive surgery, Brennan said.
“It’s very important this technology remains available,” she said. “The manufacturers and FDA should do whatever possible to make sure it remains available.”
Lawrence Muscarella, a biomedical engineer who advises hospitals nationwide on endoscope safety, said patients should ask whether a hospital has had any infections spread through duodenoscopes before undergoing ERCP.
“If it has, consider being treated at another medical center,” Muscarella wrote in an email to The Gazette.
Neither UnityPoint Health-St. Luke’s Hospital nor Mercy Medical Center, both in Cedar Rapids, has found infections linked to use of duodenoscopes, officials said. Staff at both hospitals recently received refresher training on how to clean the devices from manufacturing representatives visiting Cedar Rapids.
“During this visit, particular emphasis was given to the ERCP scopes and proper cleaning of the elevator channel” of the device, said Sarah Corizzo, spokeswoman for St. Luke’s.