Responsible for Endoscopes a wave of " superbugs "houses were redesigned in recent years with the hope that they are easier to clean and less likely to spread bacteria from patient to patient, ABC News has learned, but changes various areas created challenges continue to transfer antibiotic-resistant bugs.
Patients, the procedure duodenoscopes hospitals in Los Angeles, Connecticut , Pittsburgh and Illinois fell by bacterial infections resistant to antibiotics in the last two years, according to local health authorities and the Journal of the American Medical Association.
All three manufacturers of these areas were redesigned in the last ten years, participation in a complex region of their tips to minimize contact with bacteria of patients, ABC News has learned.
Although the tip is blocked, it is not "locked like a bubble or a can" because small tools have emerged to biopsies and other objects, Dr. J. Todd Weber, CEO prevention and response said in the middle of Disease Control Department prevention and the promotion of quality of care.
"This presents a challenge for cleaning, because it's not an open area," Weber said. "There is a mechanism in it. It is not easy finding the right brushes in this room."
Duodenoscopes are inserted through the mouth to the small intestine and reach the channels of a patient in liver and gallbladder . They contain a light, a camera system in a small catheters and other equipment in 500,000 procedures per year, according to the Food and Drug Administration of the United States. In contrast to the fields used in the colonoscopy and upper endoscopy procedure duodenoscopes used a cable channel complex lift small channels.
It is this complexity, it is difficult to clean, the FDA said in its recent communication of security since an outbreak of the CRE , an antibiotic error residence, Ronald Reagan UCLA Medical Center left two dead and infected duodenoscopes five patients the procedure. (It is not clear what role the mistake was played wear in the deaths of two patients.) The hospital said it has two duodenoscopes bacteria, the new models were due and in operation since June. Local health authorities added that the fields were purified according to the manufacturer's instructions.
"For example, is a series of detailed cleaning instructions in the device marking to clean the elevator area" communication FDA said. "However, residual organic liquids and dirt in the cracks after cleaning and disinfection of the moving parts of the lift machine contains microcracks, which can not be reached, a brush. To stay. If these fluids contain microbial contamination, the following patients can cause severe infections be exposed. "
Older models duodenoscope Tips elevator cable channel exhibited Manufacturers - Fujifilm, Olympus and Pentax - have decided to combine all the strings in their new models. Fujifilm is the first to do so in 2004, followed in 2009 by Pentax, Olympus, manufacturer describes the epidemic of UCLA, was the last to do so, and filings with the FDA as last fall, at first thought it was not necessary to obtain authorization for change, ABC News has learned.
"The port elevator cable channel will now be sealed as an independent cleaning is no longer necessary," Olympus said in a product brochure announcing the change. "The result is a faster, easier cleaning, the extent of recycling more efficient."
When I duodenoscope 39 patients were infected with antibiotic-resistant bacteria in a hospital in Illinois in 2013, CDC researchers determined that the fields are properly cleaned, but antibiotic-resistant E. coli and other bacteria found around the channel closed two months after fields have been put into use. One producer was not permitted in the study.
"Complex duodenoscopes design makes cleaning difficult," the researchers wrote in the discussion section of the paper. "It seems that these devices have the potential to remain contaminated with pathogenic bacteria is carried out also recommended after reprocessing."
How UCLA CRE cases were announced in February had Cedars-Sinai Medical Center four positive patients CRE and Hartford Hospital in Connecticut announced that 300 patients were exposed to E. coli. Duodenoscopes were two exhibitions together.
However, neither the doctors nor the health authorities want to get the fields, as these infections are rare, and the devices allow physicians, patients with life-threatening illnesses and infections, without surgery, which increases their chances of survival treatment.
Duodenoscope choice of procedure, and usually necessary for a serious symptom, says Weber.
"The value of methods using these devices is much higher than the unfortunate events," said Dr. Michael Kochman, who directs the Center of the American Association of Gastroenterology GI Innovation and Technology.
Fujifilm declined to comment, and either Olympus or Pentax was immediately available for comment.
Olympus said in an earlier statement to ABC News that he aware of reports that his duodenoscopes and with the FDA, medical organizations and customers to address the concerns work. There are additional educational materials for guests.
"While all endoscopes, including duodenoscopes requires a comprehensive treatment of patients following administration to ensure the Olympus TJF-Q180V requires special attention to cleaning and reprocessing activities, including measures of careful manual cleaning of the new treatment effectively," the company said.
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