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Medicine

Resistant Bacterial Infection Outbreak At California Hospital 132

puddingebola writes From the article: "A potentially deadly "superbug" resistant to antibiotics has infected seven patients, including two who died, and more than 160 others were exposed at Ronald Reagan UCLA Medical Center through contaminated medical instruments, the hospital revealed. The drug-resistant superbug known as CRE was likely transmitted to the Los Angeles patients by contaminated medical scopes during endoscopic procedures that took place between October 2014 and January 2015, a university statement said. " UCLA says the infections occurred via contaminated endoscopes that were sterilized according to the manufacturer's specifications. (Note: beware autoplaying video ad; adjust your volume accordingly.)
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Resistant Bacterial Infection Outbreak At California Hospital

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  • by Nutria ( 679911 ) on Thursday February 19, 2015 @10:57AM (#49087767)

    Ronald Reagan's cold dead hand stretches forth again to wreak havoc across the land!

    • by ColdWetDog ( 752185 ) on Thursday February 19, 2015 @11:27AM (#49088043) Homepage

      But, in fact, the system works. Nothing is going to be foolproof or fail safe. There will always be screw ups or just procedures that don't fix everything. However, it is telling that the hospital's surveillance systems figured out what the problem was, identified the patients at risk and presumably stopped the 'outbreak'. 32 patients, although it sounds like a lot, is probably just a couple of days worth of scopes at a big institution.

      Although not clearly delineated in TFA, it appears that the problematic instruments were endoscopes used in ERCP [wikipedia.org] procedures. These particular devices [endoscoper...essing.com] are at high risk of contamination due to their complex design.

      • by Khyber ( 864651 )

        Contamination isn't shit. If these idiots would learn how to Tyndallize their equipment instead of relying upon shit autoclaves, this wouldn't even be an issue.

        • by Bengie ( 1121981 )
          Tyndallize requires a device to be pressure cooked at 115c for 15 minute sessions, 3 days in a row. Making devices withstand pressure and heat would increase costs quite a bit, plus the cost of having each device out of service for 3 days between uses. Sounds decent enough for simple tools that are mostly metal, but more complex devices, like endoscopes may have issues.
          • by Khyber ( 864651 )

            115C? Wrong. 121C, and you only need two atmos of pressure, and it's only a single 15 minute session. Where are you getting this days in a row nonsense?

            • Re: (Score:3, Informative)

              by Anonymous Coward

              This entire thread is wrong from the very beginning, actual Tyndallization is for things that can't be boiled. You heat it to just below 100C for 15 minutes to kill active bacteria, then you store it in a damp environment for a day to encourage the spores that don't die to germinate into active bacteria and start growing again over the next 24 hours. Then you heat it again. You repeat this every day until you feel you have it clean enough. Any spores that didn't de-cloak will still be there and will bec

          • Making devices withstand pressure and heat would increase costs quite a bit.

            US Healthcare costs are already grossly inflated and the companies charge what they charge because they can get it, not because it's based in reality. I'm trying to find where I read about a medical tool that failed to market because it was priced too cheaply, and was successfully marketed and reintroduced at a higher price point. 2010 cost breakdown [aetna.com] structures and equipment is a fraction of the total expenditure. This is like the drought in California asking residents who use up 14% of the water to conserv

            • by nobuddy ( 952985 )

              Its not the regulations killing materials costs. Pharmacy costs are pretty obviously the pharmaceutical companies.
              Materials is a self inflicted wound. multiple hospitals tried to get better pricing by forming GPO companies. A good idea, but somewhere down the line the majority of them wound up in just a few dozen GPOs. Many of those merged and talked them in to long term contracts. Like 99 year contracts. In short order, everyone had to buy through a very small number of middlemen because they can control s

              • Its not the regulations killing materials costs.

                I didn't claim that, my comment about regulations was specific to software. My argument was they charge the prices they do because they can. Costs are passed on. Look at how much insurance charges.

                Materials is a self inflicted wound. multiple hospitals tried to get better pricing by forming GPO companies. A good idea, but somewhere down the line the majority of them wound up in just a few dozen GPOs. Many of those merged and talked them in to long term contracts. Like 99 year contracts.

                Interesting. Since I'm a cowboy today, why can't these organizations reorg and shirk their contracts? Probably not worth it because the vast majority of overhead typically incurred by an organization is the personnel.

        • Re:From the grave... (Score:5, Informative)

          by fsagx ( 1936954 ) on Thursday February 19, 2015 @12:16PM (#49088507)

          A flexible endoscope is cleaned in a machine more like a kitchen dishwasher than an autoclave. The scope has internal channels for shooting air and water out of a nozzle on the tip. It has a large channel to pass instruments into the patient (biopsy forceps, cauterizers, even other more narrow endoscopes). An ERCP scope has an additional channel that carries a stiff wire that is used to deflect instruments coming out the end. This channel and wire is a very tight fit, so it is more difficult to clean.

          Attachments to the channel ports should circulate the sterilizing fluids through all the channels. It's not difficult to imagine a clog preventing the fluid from circulating. Testing for leaks and clogs is part of the cleaning procedure, but in practice, of course, errors happen often:

          Similar story from just last month:
          http://www.modernhealthcare.co... [modernhealthcare.com]

          A biggy at the VA a few years ago:
          http://health.usnews.com/healt... [usnews.com]

        • instead of relying upon shit autoclaves, this wouldn't even be an issue.

          I doubt if the problem was the autoclave. It is more likely caused by sloppy procedures by a lazy operator, who didn't cook them long enough, didn't swap gloves between putting stuff in and taking stuff out, or some other dumb shortcut.

        • by Tiger4 ( 840741 )

          UCLA claims they were doing de-con per the manufacturer's recommendations. They've changed it now, which is encouraging. But had they gone off book from the start, they'd be just as liable to infect people for NOT following instructions.

          • Had they gone off-book from the start, they might have been liable for problems. Since they can demonstrate problems from going according to the book, they're a lot safer legally in coming up with a new procedure.

      • by cayenne8 ( 626475 ) on Thursday February 19, 2015 @11:54AM (#49088311) Homepage Journal
        As if I didn't already have enough reasons to *NOT* have something stuck up my ass!!
  • Well, actually resistance is surprisingly effective.

    • As always, it depends on your point of view. Are you a freedom fighter or a terrorist? A bacterium or some undeveloped, unevolved, barely conscious pond scum that is destroying the planet?

      • Destroying the planet by poisoning the atmosphere with oxygen? :)

        http://en.wikipedia.org/wiki/Great_Oxygenation_Event
  • by jamesl ( 106902 ) on Thursday February 19, 2015 @11:17AM (#49087965)

    From January 9, 2014 ...
    This investigation highlights the potential for CRE transmission following ERCP. Health-care facilities with CRE outbreaks should consider the possibility of ERCP-related transmission. If ERCP-related transmission of CRE is suspected, reprocessing and preventative maintenance procedures for ERCP endoscopes should be evaluated in consultation with the manufacturer of the endoscope and automated endoscope reprocessor, if used. In addition, expertise in the evaluation and prevention of CRE transmission are available at CDC and can be accessed via state and local health departments.
    http://www.infectioncontroltod... [infectionc...ltoday.com]

    So this "bug" went unpatched for at least a year.

  • by smooth wombat ( 796938 ) on Thursday February 19, 2015 @11:26AM (#49088037) Journal

    Sheldon Cooper: To a hospital? Full of sick people? Oh, I don't think so.

    Penny: Okay, well, your friend and his mother are there. We're going!

    Sheldon Cooper: I can't.

    Penny: Oh, don't tell me you're afraid of germs.

    Sheldon Cooper: Not all germs. Just the ones that will kill me. The same way I'm not afraid of all steak knives; just the ones that might be plunged in my thorax.

    Leonard Hofstadter: Ah-uh, fine, I'll tell Howard you didn't come because you're more concerned about your own well-being than his.

    Sheldon Cooper: I would think he would know that.

    Penny: Okay, you know what? You are unbelievable. You buy all these superhero T-shirts but when it's time for you to step up and do the right thing, you just hide in the laundry room.

    Sheldon Cooper: Fine, I'll go. Just for the record, my Aunt Ruth died in a hospital. She went in to visit my Uncle Roger, caught something, and bit the dust a week later. The two of them now share a coffee can on my mother's mantel.

    • Why do people think this show is funny?
      • It is in large part because the actors add a lot more to the performance than just the recitation of lines. That aside if you can't see the humor in a holier than though know it all being called out on his own personal cowardice then it might follow that you are possesed of the same flaws as Sheldon's character.

        • Is it personal cowardice, or pattern recognition?

          I've always thought doctor's office waiting rooms were a great way to ensure repeat business.

          • Visiting a friend in a hospital though is not like sitting around in a doctor's waiting room. Most of a modern hospital's patients aren't infected with some infectious disease. Patients are typically kept in rooms by themselves or with one other patient. There is also a lot of effort that goes into trying to keep it a relatively sterile environment. The only area of a hospital that you could accurately equate to a waiting room in a doctors office would be the emergency room, which if you are going there to

  • Oops (Score:5, Insightful)

    by Tyler Durden ( 136036 ) on Thursday February 19, 2015 @11:31AM (#49088093)

    I'm seriously regretting any anti-bacterial soap I've used over the years right about now.

    • It's not normal use that's the issue, it's overuse.

    • by Anonymous Coward

      Acid, chlorine, etc. all kill bacteria in ways that are unlikely to result in resistant strains.
      The compounds in anti-bacterial soap (triclosan for example) are not used to treat internal
      infections. Antibiotics are more specalized compounds which target bacteria and are (relatively) harmless to humans.
      The problem (if there is one) with anti-bacterial soap seems to be that a certain amount of exposure to
      bacteria is apparently good for the human immune system and widespread use of anti-bacterial compounds
      work

      • by umghhh ( 965931 )
        This and the antibiotics cooks in 3rd world do not have sewage processing plants for fluid waste from their production facilities. I mean the costs savings have to come from somewhere...
    • I'm seriously regretting any anti-bacterial soap I've used over the years right about now.

      I'm regretting the anti-bacterial soap that every moron is using, the evil marketers that tout it as a feature, and the greedy companies that capitalize on people's fear of mostly harmless bacteria.

      In case anyone is wondering, one of the best antibacterials is other bacteria, but on the other hand, there are bacteria specialized in surviving in hospital environments including both antibiotics and chemical cleaners. So not only do these soaps train antibiotic resistance in bacteria, but they also clear the w

    • Re:Oops (Score:4, Informative)

      by smellsofbikes ( 890263 ) on Thursday February 19, 2015 @12:58PM (#49088889) Journal

      I'm seriously regretting any anti-bacterial soap I've used over the years right about now.

      Don't be. We may breed triclosan-resistant bacteria by using antibacterial soap, but that doesn't mean we're breeding carbapenem-resistant bacteria -- the C in CRE -- by using triclosan. There is very little evidence that developed resistance to one type of antibiotic increases resistance to another completely unrelated antibiotic. Triclosan inhibits fatty acid synthesis, carbapenem inhibits synthesis of the peptidoglycans used in bacterial cell walls.

      • by Anonymous Coward

        Wrong. Clearly this isn't your field, so generally speaking, please stop commenting with an authoritative tone on things where you do not have the expertise or the will/ability to think through it.

        Increased mutation rates and adaptability of bacteria appear to be significant factors for development of antibiotic resistance and are selected for passage to the next generation through natural selection.

        http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2958.2006.05150.x/pdf

      • by iONiUM ( 530420 )

        Not triclosan. You shouldn't buy anti-bacterial soap with triclosan to begin with, it does nothing (probably).

        Directly from the Wikipedia page [wikipedia.org]: "Triclosan safety is under review by the FDA[15] and Health Canada.[17]" You can read the page to find out why if you're interested.

    • Soap should not be an issue, unless it contains antibiotics, which is hart to believe.

  • Always doing some new Superman spinoff.

  • "through contaminated medical instruments, the hospital revealed"
    You just said the magic words that summons their lawyers. Law suit time!
    • by jedidiah ( 1196 )

      Someone should be answering to a judge over this.

      If the DA won't do it then it's up to those "sleazy ambulance chasers".

    • by sjames ( 1099 )

      On the other side, I'll bet the hospital expects the patients to pay the full bill, including the bill for treatment (successful or not) for the disease the hospital gave them. It's no wonder people are so quick to sue.

  • Ahh, Endoscope
    Pass me the tube so I can take a poke
    1 push, 2 push, 3 push, 4 push, 5 I'm feelin deep inside
    Leaning to the side in my Ophthalmic ride
    With the KY gangsta glide
    Woo!, hey now ya know
    Inhale, exhale with my flow
    Breakaway, come again like this
    Hey G promise me use two hands don't miss
    Cuz if you do, it break you get broke
    Me and Mista G and the endoscope

  • Clearly the reason these patients died is because the "Ronald Reagen" medical center used too "conservative" an approach to their treatment.
  • If they were cleaned per the Manufacturer's specs (which feels a little like the fox cleaning the hen house) then said company should be fined into oblivion and all involved with writing and approving said procedures held in gaol for quite some time.

    But America, so jack shit will happen.
  • There is a whole family of bacteria in enterobacteriaceae, the E of CRE, including from E. coli to Salmonella. The brilliant story doesn't bother to mention which bacteria is causing the infections.
  • Look up CRE (Score:4, Interesting)

    by Cafe Alpha ( 891670 ) on Thursday February 19, 2015 @05:33PM (#49091451) Journal

    Current estimates are that 3% of patients in ICU test positive and 1/3 of people in nursing homes.

    You read that right, 1/3. Also multiple types of bacteria are CRE. It means they have an enzyme that breaks down a class of antibotics.

    This has been sneaking up on us for a while.

    I think that the problem is, most bacteria are usually harmless, but these can't be killed easy, and if they ever turn into blood infections the mortality rate seems to be 50%.

Egotist: A person of low taste, more interested in himself than in me. -- Ambrose Bierce

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