A 'culture' of safety can cut superbug infection risk

By Leslie Small

In the wake of the carbapenem-resistant Enterobacteriaceae (CRE), outbreaks, the ECRI Institute, a nonprofit healthcare research firm, has heard from a number of hospitals seeking advice about safe duodenoscope use, Chris Lavanchy, pictured right, ECRI's engineering director for health devices, told FierceHealthcare in an exclusive interview.

"I think awareness about this issue has been raised dramatically over the last six months, which is really tremendous," he said.

However, awareness alone isn't enough to help hospitals keep patients safe from infections, which is why ECRI issued a "high-priority hazard report" in March that culled advice from engineers, physicians, microbiologists, federal agencies such as the Food and Drug Administration and Centers for Disease Control and Prevention, as well as some of the hospitals that have experienced duodenoscope-associated infections.

In the report, ECRI recommends hospitals take a stratified approach to assessing and mitigating the infection risks associated with their reusable surgical devices. First, hospitals should culture their reusable devices to determine if there's any microbial growth after standard cleaning procedures. If the cultures determine that normal cleaning procedures are inadequate, hospitals may want to culture scopes after each use and subsequent reprocessing cycle before they use them again on patients.

Individual culturing may not be very practical for most hospitals, however, because it may be difficult to take a duodenoscope out of commission for the 48 hours it takes for the culture to grow, Lavanchy said. Thus, this step may not be warranted for hospitals that have a low CRE risk, he said.

This may be why Virginia Mason Medical Center in Seattle, which experienced a duodenoscope-linked CRE outbreak, simply decided to spend $1 million to purchase a new set of scopes, FierceHealthcare previously reported.

UCLA, on the other hand, switched to an older method of cleaning its duodenoscopes, ethylene oxide gas sterilization, after the deadly CRE outbreak at its facility. While UCLA officials have said there have been no more outbreaks since switching to the method, the Department of Veterans Affairs (VA) has said it is concerned about the patient safety risks associated with this method because of the possibility that the gas could linger on the scopes after cleaning.

Lavanchy echoed the VA's concerns. "We're not convinced at this point that ethylene oxide is a long-term solution," he said. "That's why we've tried to move away from that and really point people toward culturing instead."

Even if hospitals decide not to culture their duodenoscopes after each use, ECRI recommends that all hospitals culture their medical devices weekly to pinpoint "variability in the quality of their reprocessing" and potentially stop outbreaks in their tracks, Lavanchy said.

But CRE itself is nothing more than a "canary in a coal mine"--meaning it has alerted the public at large to the already existing danger posed by superbugs. "It's not really a new issue. It's just that now, stakes are so much higher," he said.

A 'culture' of safety can cut superbug infection risk