The FDA released a warning this week about possible contamination risks involved with specialized endoscopes after seven people became infected with an antibiotic resistant bacteria after undergoing procedures at a California hospital. However, while the news is serious, it affects just a small percentage of patients who undergo endoscopic procedures. "There are a lot of procedures that involve scopes," says Jeanmarie Mayer, MD, hospital epidemiologist for the University of Utah Health Hospitals and Clinics. "The FDA alert is for Endoscopic Retrograde Cholangiopancreatography or 'ERCP' scopes, which may be used to treat individuals that have disease of the pancreas, liver, or bile ducts." The ERCP scope is different than the endoscope used for routine upper gastrointestinal endoscopy or colonoscopy. The ERCP scope is more intricate than other endoscopes and can be difficult to clean and disinfect.
The FDA is recommending that facilities and staff that use ERCP scopes closely follow manufacturer's instructions to decrease the risk of contamination. University of Utah Health Care Endoscopy Center has created a checklist to make sure that every step in the meticulous process is followed. "The endoscopy team processes the device immediately after use," says Mayer. "They take special care and repeat three times a critical manual cleaning step from hard to reach areas of the ERCP scope," says Mayer. University of Utah Health Care is also working on other ways to make ERCP safer. "Although CDC currently doesn't recommend culturing ERCP scopes unless a problem occurs, we are working on a protocol to take baseline and regular cultures to test for potential bacteria," says Mayer.
Utah also has a geographic advantage when it comes to the risk of this particular antibiotic resistant bacteria being present. "The bacteria causing concern is called Carbapenem-Resistant Enterobacteriaceae or CRE," says Mayer. "It is difficult to treat because these bacteria are resistant to many antibiotics. While infections caused by CRE can be found in hospitalized patients or residents in long-term-care facilities, it is uncommon for us to see CRE in our health care system, or in our geographic region."
Despite the precautions taken in processing ERCP scopes, there is always some risk. "You have to carefully weigh the risk and benefit of doing any procedure," says Mayer. "ERCP is an important and possibly lifesaving treatment that can potentially avoid the need for more invasive procedures such as surgery." Patients who are concerned should talk to their doctors. "Your physician and healthcare team at the University of Utah want to answer any questions you may have," she says.