Could a simple plastic sheath have prevented the UCLA superbug outbreak?

03/06/2015

The answer to the question posed in the headline is, in theory, yes. The reality is a bit more complicated.

A type of endoscope contaminated with carbapenem-resistant enterobacteriaceae (CRE) has contributed to the death of two people who were treated at the UCLA Ronald Reagan Medical Center, with 179 patients possibly exposed to the antibiotic-resistant superbug, as reported last month in PlasticsToday. The first of what will probably be several lawsuits was filed on Feb. 23 by Aaron Young, who contends that the Q180V scope manufactured by Olympus that was used in the procedure included a safety cleaning protocol for an older design of the device. That cleaning process wasn't effective in removing all residual body fluids and organic debris, alleges Young.

Whether or not Olympus was negligent will be decided by the courts. It is one of three medical device manufacturers—the others are Fujifilm and Pentax—that manufacture this specialized endoscope, called an endoscopic retrograde cholangiopancreatography (ERCP) duodenoscope. The design of the device, which includes what FDA calls a "movable ‘elevator' mechanism...[that] changes the angle of the accessory exiting the accessory channel," makes it difficult to clean thoroughly. According to news reports, medical personnel at UCLA followed the cleaning procedure recommended by the manufacturer. However, the narrow channels and ports in endoscopes are hard to reach and disinfect, making it extremely difficult to remove 100% of microbes. The mechanism of the duodenoscope adds to this complexity. One solution that is used on some endoscopes to prevent potential contamination is a single-use plastic sheath.
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