APIC, SHEA Issue Call to Action on CRE Endoscopy Outbreaks

February 26th, 2015

By Gary Evans

Two of the nation’s leading infection control associations are urging their members to use their considerable skills in health care epidemiology to prevent additional endoscopy-related outbreaks of carbapenem-resistant Enterobacteriaceae (CRE).

In light of recent outbreaks of highly drug resistant CRE linked to endoscopic retrograde cholangiopancreatography (ERCP) procedures, the Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) issued a call to action to their respective memberships.

“Infection preventionists and healthcare epidemiologists are experts in tracking down the sources of infection and limiting their spread in healthcare facilities and can play a significant role in the endoscopy department’s quality improvement program as it relates to scope processing,” APIC and SHEA said in a statement. “After observing the cleaning and disinfecting processes and asking questions so that each step of the process is understood, [they] may visit the department regularly to observe scope cleaning practices and reinforce the importance of the work being done.”

The APIC/SHEA statement said that the Centers for Disease Control and Prevention and the Food and Drug Administration are working together to develop “optimal protocols” for reprocessing duodenoscopes, the complex instrument used in ERCP procedures. The upper endoscopy procedure is performed on some half million U.S. patients annually, some of whom have been infected with CRE in a series of outbreaks in recent years. As infection preventionists are well aware, CRE infections are practically untreatable because few if any antibiotics are effective against them.

“Because duodenoscopes are more complex than other endoscope instruments, it requires meticulous attention to detail and step-by-step precision to render them safe for re-use,” APIC and SHEA stated.

IPs and healthcare epidemiologists can evaluate “human factors” including the lighting and set up of the cleaning area, and assess the level of distractions, interruptions in the process, or demands for rapid scope turn-around, the associations said.

“Some departments with many patients coming in and out for these procedures may pressure staff to turn scopes around quickly,” APIC and SHEA stated. “Infection preventionists and health care epidemiologist must lend their support to conscientious endoscopy staff who understand the importance of taking the time needed to do a thorough job. “[Our members] must help promote a culture in which healthcare workers are empowered to speak up if they believe there is an issue that could impact patient safety."

Gary Evans is Executive Editor of Hospital Infection Control & Prevention (HIC) and Hospital Employee Health (HEH). As HIC editor and writer since 1987, Evans has interviewed hundreds of infection control experts and written numerous articles on wide ranging topics that include antibiotic-resistant pathogens, bloodborne infections, outbreaks and emerging infectious diseases like SARS, H1N1 pandemic influenza A, MERS and Ebola. Evans coverage has won numerous awards, including five from the National Press Club for analytical reporting.