Secrecy about superbugs could put patient safety in jeopardy

The all-too-common secrecy surrounding superbug outbreaks at U.S. hospitals undermines promising strides the healthcare industry has made in the push for transparency, the Los Angeles Times reports.  

Health investigators on the federal, state and local level often keep outbreaks confidential in order to encourage hospitals to report them openly, according to the newspaper. Such is the case in L.A., according to Laurene Mascola, M.D., chief of the county's acute communicable disease control program. She also said county officials would disclose an outbreak if they believed it to be in the public's interest.

But outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) tied to a specialized device known as a duodenoscope may illustrate the danger of a lack of public disclosure, according to the L.A. Times. A duodenoscope-linked CRE outbreak began in Florida hospitals--which still have not been named--as early as 2008, but while the hospital officials discussed the problem with the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), no one publicly disclosed the outbreak until doctors wrote about it in a medical journal years later.

The same type of outbreak then cropped up at UCLA and Cedars-Sinai Medical Center, and as was the case in the Florida incidents, the problem stemmed primarily from the complicated design of duodenoscopes, which makes them difficult to clean. For its part, the FDA first warned hospitals in February that following manufacturers' cleaning instructions may not be sufficient, then the following month issued new guidelines that require manufacturers to prove the devices can be safely cleaned. But it has been criticized for not acting more quickly.

The federal government requires hospitals to track and report rates of only six common types of infections, a list that does not include CRE, FierceHealthcare has reported. Indeed, the CDC leaves it up to state and local health officials whether to tell the public about such outbreaks, a spokeswoman told the L.A. Times.

In the case of the Florida outbreak, the CDC and FDA didn't tell the public about it because investigators found that hospital staff failed to clean the scopes properly, an issue the FDA had already sent a general warning about in 2009, according to the newspaper. But had the agencies disclosed the outbreak, regulators might have recognized dangerous flaws in the duodenoscopes' design sooner, said Peter Mendel, who studies hospital-acquired infections for the RAND Corp. in Santa Monica, California. "People would realize there was accountability," he told the newspaper.

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