Infected duodenoscopes are again being blamed for a fatal outbreak of carbapenem-resistant Enterobacteriaceae (CRE), this time at UCLA's Ronald Reagan Medical Center in Los Angeles, where at least 7 patients have been infected and 2 have died. The hospital is in the process of notifying 179 other patients that they, too, may have been exposed to the defiant superbug, according to the Los Angeles Times.

The outbreak follows closely on the heels of a similar outbreak at Virginia Mason Medical Center in Seattle, Wash., reported last month, and follows a pattern that reveals the intense difficulty involved in adequately disinfecting the scopes. Similar to facilities in Pittsburgh, Chicago and Seattle, UCLA maintains that it had been cleaning and sterilizing the scopes "according to standards stipulated by the manufacturer," but says it has now switched to a more extensive decontamination process.

After its outbreak, Seattle's Virginia Mason began quarantining its scopes for 48 hours to make sure they're free of CRE and other dangerous microorganisms. Pittsburgh's UPMC Presbyterian and suburban Chicago's Advocate Lutheran General Hospital both began using ethylene oxide gas sterilization after experiencing CRE outbreaks.

Duodenoscopes are used in minimally invasive endoscopic retrograde cholangiopancreatography (ERCP) procedures on hundreds of thousands of patients every year and despite the outbreaks, health officials stress their value in treating various digestive ailments.

Experts say the scopes' elevator channels, which physicians use to maneuver in tight spaces, are where CRE and other bacteria are likely to build up and ultimately resist standard disinfection efforts. Olympus Medical Systems Group, which supplied UCLA's scopes, says it's working with the FDA, physician groups and hospitals to address safety concerns.

Jim Burger