Edmiston Jr., PhD, CIC, emeritus professor of surgery at the Medical
College of Wisconsin in Milwaukee and director of its Surgical
Microbiology Research Laboratory. "We've always suspected these
infections occurred at a much greater frequency with duodeno-
scopes."
Some CRE outbreaks may even go unrecognized, says Dr. Edmiston,
who co-authored an examination of the infection risks in scope repro-
cessing for the December 2014 AORN Journal, since the causes of
infection in critically ill patients may be attributed to other factors and
the majority of non-critically-ill patients may wind up colonized but
not infected by the bug. "As with Ebola, this is going to be an evolving
topic," he says.
Unspoken warning?
What's more, the U.S. Food and Drug Administration has been aware
of the hazards that duodenoscopes may present for more than 2
years, although it wasn't until after UCLA reported its outbreak that
the agency spoke up on the matter.
In a safety communication, FDA officials noted that they had
received 75 reports involving 135 patients of possible cross-contami-
nation from reprocessed scopes between January 2013 and December
2014 (tinyurl.com/mrjo4g6).
A further alert warns, "Some parts of the scopes may be extremely
difficult to access and effective cleaning of all areas of the duodeno-
scope may not be possible," adding that "a recent FDA engineering
assessment and a growing body of literature have identified design
issues in duodenoscopes that complicate reprocessing of these
devices." (tinyurl.com/n42nf7c)
At issue is a movable "elevator" mechanism at the tip that flexes the
angle of catheters or other accessories threaded through the device's
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