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This post was updated March 9 to reflect additional coverage of superbug outbreaks.
“Go beyond finger-pointing and look for systemic failures.” This advice to journalists on the patient safety beat, from health policy expert Dr. Ashish Jah during our Q&A earlier this month, came to mind as I read Chad Terhune’s excellent reporting for the Los Angeles Times on a recent superbug outbreak linked to contaminated endoscopes–and two deaths–at UCLA’s Ronald Reagan Medical Center.
Rather than hunting for a bad-apple doctor (a common but insufficient approach on this beat, as Jah noted), Terhune and several fellow Times reporters set the LA outbreak in a broader context and explored recurring questions about the way this particular endoscope, called a duodenoscope, is designed, cleaned, and regulated–helping to spur a response from the FDA.
Terhune laid out the problem on Feb. 18: 179 patients may have been explosed to potentially deadly bacteria from contaminated instruments designed to examine the digestive tract; two people died. As soon as the hospital learned of the problem, it notified others who had undergone the procedure using this particular endoscope between October and January. The hospital told the paper it had been cleaning the devices according to the manufacturer’s instructions, but acknowledged it had changed its cleaning procedures after discovering the infection, which kills 40 to 50 percent of patients who contract it.
Terhune told readers there had been similar outbreaks in other states. “The infections at UCLA,” he wrote, “are the latest in a series of outbreaks linked to duodenoscopes in recent years that have sickened patients at hospitals in Pennsylvania, Illinois, and Seattle.” Lawrence Muscarella, a hospital safety consultant and endoscope expert, told the Times that these outbreaks “could collectively be the most significant instance of disease transmission ever linked to a contaminated reusable medical instrument.”
Terhune then took his reporting to the doorstep of the FDA, which approved the endoscope in question. On Feb. 19, with help from Washington bureau reporters Noam Levy and David Willman, Terhune reported that the FDA had conceded that this endoscope “may be so flawed it cannot be properly cleaned,” but that the agency “stopped short of recalling the device or outlining any new sterilization procedures.” Further:
The US Food and Drug Administration has known about the potential problems for more than two years, and took action only after the Times reported this week that two patients died in a new superbug outbreak at UCLA’s Ronald Reagan Medical Center.
In tackling the subject of superbugs and dirty medical equipment, the Times was following some recent good work by other publications including USA Today, Modern Healthcare, the Seattle Times, and the Philadelphia Inquirer.
The cumulative press coverage seems to have had an impact. Shortly after the LA Times stories appeared, the FDA acknowledged it had never received data from manufacturers and device-cleaning procedures, and announced it was asking companies to provide evidence that their recommended methods work.
Coverage has been sustained since then, too. The Washington Post reported in early March about Congressional demands on the FDA for a “a forceful, substantive response” to superbug outbreaks.
CNN weighed in with a report that Olympus, the manufacturer of the devices used in the UCLA outbreaks, had not obtained FDA permission to sell the device. And the superbug has hit another Los Angeles hospital, Cedars-Sinai Medical Center, and the Times has continued its coverage. So many outlets chasing this story can only serve the public better.
To jump back to the earlier LA Times reporting: The paper also offered two explainers, one a superbug primer and another describing the difficulties of cleaning the endoscopes. UCLA now sterilizes its scopes with gas, a process that carries its own risks. Virginia Mason Medical Center in Seattle, site of a separate recent outbreak, takes the endoscopes out of service for 48 hours to watch for bacteria growth and had to buy 20 additional scopes to make up for the down time. “We’re in this interim period of what to do before a better mousetrap is built,” Andrew Ross, chief of gastroenterology at Virginia Mason, told Times reporters.
And that brings up the patient story. All this good reporting in Los Angeles can’t help but leave patients confused and vulnerable if they need a medical procedure involving this endoscope (and more than 570,000 such procedures are performed every year, according the Times). Waiting for the FDA to decide if the harms do outweigh the benefits or until hospitals find the perfect way to clean these instruments leaves patients in a kind of information limboland.
Reporters who want to help might start with tips for patients considering the procedure. What should they do? Find out what kind of endoscope will be used, perhaps, and ask about cleaning procedures. (The Philadelphia Inquirer‘s Tom Avril, reporting on a recent outbreak there, took the important step of finding out which hospitals were using the possibly safer gas method of sterilization; apparently none were). Research the hospital’s safety track record (the Times reported UCLA Medical Center had struggled with patient safety, receiving a failing grade in 2012 and a C in the latest patient safety ratings from the nonprofit Leapfrog Group). In our recent Q&A, Dr. Jha told me we are now at a point where we are asking patients who are sick and often in pain to be their own advocates for safety because the system hasn’t done its job. The Times‘ first-rate reporting on endoscopes confirms that.
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