- UCLA Health System is dealing with a major superbug crisis after carbapenem-resistant Enterobacteriaceae (CRE), spread by dirty endoscopes, was implicated in the deaths of two patients and the sickening of seven more. With up to 170 patients at risk from the highly resistant bacteria, hospital acquired infections are once again in the limelight as a serious patient safety problem.
The incident occurred at Ronald Reagan UCLA Medical Center, major news outlets are reporting, after two endoscopes were used in multiple complex procedures designed to diagnose pancreaticobiliary conditions such as pancreatitis, gallstones, and pancreatic cancer. Patients who underwent procedures conducted between October 2014 and January 2015 with the infected equipment have been notified by letter.
“UCLA sterilized the scopes according to the standards stipulated by the manufacturer,” the hospital said in a public statement. “However, an internal investigation determined that CRE bacteria may have been transmitted during a procedure that uses this specialized scope to diagnose and treat pancreaticobiliary diseases, and may have been a contributing factor in the death of two patients. A total of seven patients were infected.”
“The two scopes involved with the infection were immediately removed and UCLA is now utilizing a decontamination process that goes above and beyond manufacturer and national standards,” the statement adds. “Both the Los Angeles County Department of Health Services and the California Department of Public Health were notified as soon as the bacteria were detected.”
CRE is among the most deadly and most highly resistant of the superbugs, which include the more familiar MRSA and C. difficile. Despite a 17% drop in hospital-acquired infections over the past three years thanks to dedication from HHS and the nation’s healthcare providers, a lack of widespread antibiotic stewardship, chronic overprescribing by primary care and hospital-based physicians, and inadequate hygiene monitoring in hospitals have contributed to the ongoing risk of patient harm.
In December, 721 hospitals forfeited $373 million in Medicare payments due to quality penalties associated with hospital acquired infections and other inpatient conditions such as bed sores and falls. Academic medical centers, including Ronald Regan UCLA Medical Center, were especially prevalent on the list.
The facility received the lowest possible score for the incidence of patient harm resulting from serious complications, including falls, bed sores, and blood clots, and achieved similarly poor ratings for central-line associated blood stream infections and catheter-associated urinary tract infections. Overall, Ronald Reagan Medical Center received a score of 8.7 for hospital acquired conditions, with 10 being the worst possible rating.
Multiple studies have found that hospitals generally lack health IT tools that may help to reduce the frequency and number of hospital acquired infections, including clinical decision support infrastructure and predictive analytics that may help them choose the right treatments for specific strains of superbugs.
A Duke University study from 2014 found that 38% of patients with bloodstream infections received the wrong antibiotic the first time they presented with symptoms. Patients recently rehospitalized or those coming from the nursing home setting were the most likely to be incorrectly diagnosed. Patients that do receive antibiotics are often prescribed them wrongly. According to the CDC, up to 78% of hospitals may be overusing antibiotics, which then leads to increased resistance in newly mutated superbugs and a financial impact of more than $12 million per year.
“Overuse and inappropriate use of antimicrobials is a major public health issue and contributes to patient harm, antimicrobial resistance, and unnecessary healthcare costs,” the CDC says. “It has been recognized for several decades that of patients receiving antimicrobial therapy, up to half receive unnecessary or inappropriate therapy, including redundant therapy. Focusing on redundant or duplicate antimicrobial therapy is one recommended strategy to reduce overutilization and its attendant effects on patient safety and hospital costs.”
Patients at UCLA who may have been affected by the contaminated equipment have been sent home test kits that will be analyzed by hospital staff. An inspection of the facility by the county health department found no infection control breaches, NBC reports. Joshua Bobrowsky from the LA County Department of Public Health notes that the design of endoscopic equipment makes it difficult to sterilize completely, and the devices have been implicated in infection outbreaks in the past.