The “Superbug” was super preventable
RECENT “SUPERBUG” OUTBREAK MAKES GOOD CASE FOR DISPOSABLE PRODUCTS
As seen in recent headlines, the Ronald Reagan UCLA Medical Center notified 179 patients they may have been exposed to carbapenem-resistant Enterobacteriaceae (CRE) from contaminated duodenoscopes. CRE is highly resistant to antibiotics and can kill up to 50 percent of infected patients (1). A total of seven UCLA patients were infected and two have died since February 24 (2).
The duodenoscopes at the center of the recent “superbug” poses a great question: Are reusable products always best practice?
Reusable medical tools clearly have irreplaceable benefits. They, first and foremost, are cost effective by avoiding the need to reorder and restock inventory. Secondly, the quality of reusable products is typically higher than their one-time use counterparts.
So where should the line be drawn between using a product that is reusable versus a product that is intended for one-time use? The answer is simple: the cleaning process. If the risk of using a reusable product outweighs the reward, then the switch should be a no-brainer.
The biggest debate surrounding the UCLA controversy is the lack of effective cleaning methods. Duodenoscopes, compared to other endoscopes, improve the efficiency and effectiveness of ERCP, according to the FDA. However, they are challenging to clean. Some parts of the scopes are difficult to access and effective cleaning of all areas may not actually be possible (3). In fact, an 18-year-old infected UCLA patient is now allegedly suing the duodenoscope manufacturer for negligence and failing to provide an effective and validated reprocessing protocol (1).
If a medical tool—regardless of its purpose—is going to be used on more than one patient, then extensive cleaning procedures need to be outlined to prevent infection and cross-contamination. If effective cleaning cannot be guaranteed between uses, clinicians should consider alternatives such as disposable products.
For example, clinicians could utilize disposable instruments that are pre-sterilized and individually packaged. This eliminates any chance of human error in the cleaning process. A disposable speculum is another example of a common product that may be more effective than a reusable speculum. If discarded after use, there is a much lower risk of cross-contamination between patients.
Reusable products and disposable products both have their benefits; however, the key to maintaining patient safety is assessing the context of its use and selecting the most effective option.