This is about superbugs, medical equipment and the great job VA is doing to provide safe, modern health care for our Veterans.
CRE are a family of superbugs. You might have seen media stories about infections due to these bacteria at some private sector hospitals. CRE are carbapenem-resistant Enterobacteriaceae. That link will take you to the CDC with a lot more information about these bacteria, which are resistant to treatment by the antibiotics usually used to fight them. Superbug infections have occurred more often in the last several years. A Google search of superbugs today will provide more than 600,000 links. People are right to be concerned.
In some instances, it is believed that people got CRE from a piece of medical equipment called a duodenoscope. The doctor uses it to view a patient’s pancreatic and bile ducts using a flexible, lighted tube.
Out of concern for Veterans, and to be sure that no CRE transmission through contaminated duodenoscopes was occurring at VA hospitals, VA conducted a review to determine if there was evidence of CRE infections in Veterans who underwent the procedure with a duodenoscope.
There were over 55,000 duodenoscopy and related procedures performed on 40,329 Veteran patients between 2010 and 2015. Of these more than 40,000 patients, a total of 97 patients from 39 different VA facilities who underwent these procedures were found to have CRE.
For many patients there was no connection because CRE infection occurred before the patient had the procedure. But we needed to know if other patients with a superbug had picked it up from another patient who might have infected the duodenoscope. So we looked at their records and matched the duodenoscope make, model and serial number.
We identified 59 Veterans who had a procedure within 6 months of another Veteran at the same facility. For 49 of them, a different duodenoscope was used for the two procedures, so the bacteria could not have been transmitted between the two Veterans.
For the remaining 10 Veterans, the possibility of transmission could not be completely excluded. For some, the duodenoscope model and serial number were unavailable. For others, the duodenoscope with the same model and serial number was used for both procedures, but they were performed 3-4 months apart, and there was no evidence of superbug infection in any of the patients who had a procedure using the same equipment between the procedures of the patients under investigation.
I believe these findings demonstrate the effectiveness of VA medical center policies and processes. Our medical centers employ high quality sterile processing of reusable medical equipment to prevent such infections.
We have the tools to systematically investigate potential problems of the kind reported in other health care facilities. Our prompt and thorough investigation of possible transmission of CRE infections by duodenoscopes demonstrated that transmission of these infections in our system was highly unlikely.
Veterans, other stakeholders, and the public can be assured that VA will continue applying the highest possible standards for cleaning all reusable medical equipment, monitoring for any infections that might develop, rapidly investigating potential breaches, and applying robust preventive measures when infections do occur within its facilities.
by Mark Holodniy
Director, Public Health Surveillance and Research