UCLA statement on notification of patients regarding endoscopic procedures
Updated Febrary 20, 2015
The safety of our patients is of our utmost concern.
You may have heard of an unfortunate outbreak of carbapenem resistant Enterobacteriaceae (CRE) bacteria that occurred at Ronald Reagan UCLA Medical Center during complex endoscopic procedures that took place between October 2014 and January 2015.
We want to assure you that it is safe to receive care at UCLA.
- Only patients who underwent this particular procedure during that time frame are affected. No patients today at UCLA, including those undergoing endoscopic procedures, operative procedures, or clinic visits are at risk from this “super-bug” outbreak.
- UCLA Health has instituted stricter sterilization procedures for the particular scopes that were used, so that we now have one of the most stringent scope protocols in the United States.
- Visitors, volunteers and employees are not at risk.
If you have any concerns, please contact your doctor or call UCLA Clinical Epidemiology and Infection Prevention at 310-794-0189.
Updated Febrary 19, 2015 at 2:30 pm PT
The UCLA Health System notified 179 patients on Feb. 18 that they may have been exposed last fall to the carbapenem-resistant enterobacteriaceae (CRE) bacteria during an endoscopic procedure to diagnose and treat diseases of the liver, bile ducts and pancreas at Ronald Reagan UCLA Medical Center. A total of seven patients were infected; the infection was a contributing factor in the death of two patients.
Only patients who underwent these endoscopic procedures from October 3 to January 28 are at risk of infection. Those patients are being offered a free home testing kit for analysis at UCLA to determine if they carry the bacteria in their intestines.
UCLA followed both national guidelines and the sterilization standards stipulated by Olympus Medical Systems Group, the instrument’s manufacturer. However, an internal investigation determined in late January that CRE may have been transmitted by two of the seven Olympus scopes used by the hospital during the four-month period.
UCLA immediately began reviewing every patient record to determine which patients underwent the procedure using this type of scope between October and January. In an abundance of caution, the hospital has notified all 179 patients who were examined with one of the seven instruments during that time.
The two infected scopes were immediately removed from use for return to Olympus. UCLA currently performs a more stringent decontamination process that exceeds both the manufacturer’s standards and national guidelines. Hospital staff thoroughly clean the instrument and place it in an automated machine for disinfection. Then the instrument is sent off-site for a second sterilization process using a gas called ethylene oxide.
The Los Angeles County Department of Health and California Department of Public Health were notified as soon as the outbreak was detected. CRE exposures using the same type of scope have been reported in other U.S. hospitals. Concerned patients may contact their primary care physician or UCLA’s clinical epidemiology and infection prevention department at 310-794-0189.
Patient hotline: 310-794-0189
Updated February 18, 2015
The UCLA Health System has notified more than 100 patients that they may have been infected by a “superbug” bacteria during complex endoscopic procedures that took place between October 2014 and January 2015. The patients are being offered free home testing kits that would be analyzed at UCLA.
UCLA sterilized the scopes according to the standards stipulated by the manufacturer. However, an internal investigation determined that carbapenem-resistant Enterobacteriaceae (CRE) bacteria may have been transmitted during a procedure that uses this specialized scope to diagnose and treat pancreaticobiliary diseases and may have been a contributing factor in the death of two patients. A total of seven patients were infected.
Similar CRE exposures using the same type of scope recently have been reported in other hospitals in the United States. The two scopes involved with the infection were immediately removed and UCLA is now utilizing a decontamination process that goes above and beyond manufacturer and national standards. Both the Los Angeles County Department of Health Services and the California Department of Public Health were notified as soon as the bacteria were detected.
Patient hotline: 310-794-0189
What are CRE?
CRE, which stands for Carbapenem-resistant Enterobacteriaceae, are a family of bacteria that can be difficult to treat because they are resistant to many commonly used antibiotics. CRE are an increasing public health problem throughout the world.
Enterobacteriaceae are a family of bacteria, including Klebsiella, E. coli and many other bacteria, that normally live in the colon of all people. Klebsiella and E. coli can become CRE when they obtain resistance mechanisms that make them more difficult to treat. While these bacteria usually do not cause any problems in healthy patients, they can cause infections in patients who have other serious medical problems or who are undergoing operations or other invasive procedures.
How were patients exposed to CRE at UCLA?
UCLA Clinical Epidemiology and Infection Prevention staff identified a small group of infections with CRE that appeared to happen after endoscopic retrograde cholangiopancreatography (ERCP). After further investigation with the assistance of the Los Angeles County Department of Public Health, it was determined that the routine cleaning of the ERCP scopes as recommended by the scope manufacturer does not completely eradicate CRE as it does for other bacteria and viruses. After discussion with local and national public health officials, it appears that the ERCP scopes will require additional cleaning techniques beyond what is recommended by the manufacturer or significant redesign of parts of the scope.
If patients did not have an ERCP procedure, are they still at risk of infection at UCLA?
No. Only patients who underwent ERCP between October 3, 2014 and January 28, 2015 may be at risk of exposure.
Do CRE always cause infections?
No. The most common types of CRE are Klebsiella and E. coli, both germs that are present in the colon of all people. CRE can live in the colon and not cause any health problems; this is called “colonization.” While most people who are colonized will clear the organism over time, there is a small chance that CRE can cause an infection.
Most people who develop an infection with CRE have underlying medical issues or have undergone a medical procedure.
How do patients know if they have CRE?
If a patient has symptoms of fever or chills, it is possible he or she could have an active infection, though this is very uncommon. If patients have any of these symptoms, they should contact their primary doctor immediately or call UCLA Clinical Epidemiology and Infection Prevention at 310-794-0189 for guidance.
Patients without symptoms of infection may still be colonized with CRE in their colon. We are providing a screening test for patients to perform at home, which will be processed at a UCLA Laboratory. UCLA Clinical Epidemiology will contact patients with the results and answer questions.
What is the chance that a patient has CRE?
In a similar outbreak at another hospital, it was found that about 10% of patients who underwent ERCP later had CRE colonizing their colon.
What if a patient is colonized with CRE?
Most people who are colonized with CRE will eventually clear the bacteria from their colon if they are not exposed to antibiotics; however, some people may be colonized longer. Because Klebsiella is normally part of the millions of bacteria that live in the colon, carriers will likely not have any problems with the bacteria. It is important for a patient to know if they are colonized; their doctor may choose to treat them differently in the unlikely event of an infection. If a patient is identified as a CRE carrier, UCLA will ask healthcare workers to wear gowns and gloves if the patient is admitted to the hospital to decrease the risk of transmission of this germ to other patients. Unfortunately, there is no reliable way of eradicating CRE from the colon, though with time, it is likely that it will be crowded out by other bacterial strains that do not have antibiotic resistance.
What is UCLA doing to ensure that no other patients are exposed?
In addition to the cleaning process recommended by the ERCP and linear endoscopic ultrasound scope manufacturer, UCLA has begun outsourcing gas sterilization of these scopes after this process. We will also be performing cultures on scopes in coordination with the LA County of Public Health.
UCLA Health Science Media Relations