Baystate Noble Hospital alerts 293 colonoscopy patients to ‘small risk’ of infection due to improper disinfection



Last modified: Sunday, January 24, 2016

A lapse in disinfection procedures means that 293 patients who had colonoscopies at Baystate Noble Hospital in Westfield, including 13 Hampshire County residents, may have been exposed to blood-borne pathogens that could put them at risk of HIV, hepatitis B and hepatitis C, hospital officials said Friday.

The risk of infection from the inadequately cleaned devices is low, they stressed. None of the colonoscopy patients has reported an infection.

“We have no evidence that this has caused harm,” Dr. Sarah Haessler, an infectious-disease physician and Baystate’s head epidemiologist, said in an interview Friday. “But obviously testing is just getting started.”

Patients who had colonoscopies at Baystate Noble between June 2012 and April 2013 face a small risk of infection due to improperly disinfected colonoscopes used in some procedures during that time. These patients have been notified of the risk and are being offered free screenings. The hospital sent letters to the 293 patients on Wednesday.

“We have a very specific idea of who those folks are,” said Baystate Health spokesman Ben Craft. “We’re trying to limit anxiety as much as possible.”

Patients who have not been notified have no reason to worry, according to a statement issued Friday by the hospital.

The problem dates to June 2012, when the hospital began using new colonoscopes that required a different disinfection procedure than its previous instruments. Noble, which joined Baystate Health in July 2015, has three colonoscopes manufactured by Olympus Corp.

Colonoscopes are thin, flexible, lighted tubes with cameras at the tip that are inserted through the anus to look for growths in the colon called polyps. Within the tubes, there are multiple channels: some use suction to remove materials while others spout air and water to help clean the gastrointestinal tract. Noble’s new devices had an additional water irrigation channel, but the hospital was missing an adaptor it needed to run that channel through the last, automated stage of its disinfection process, Haessler said.

This particular channel is used to flush sterile saline into the colon, not to transport biopsy specimen, meaning it was a “fundamentally clean channel in terms of utility in terms of the actual process of a colonoscopy,” said Dr. Stanley Strzempko, interim chief medical officer of Baystate Noble Hospital.

“Due to the function of the water irrigation channel and the phase of disinfection at which the failure occurred, the risk to patients is very low,” Haessler said in the statement. “However, that risk is not zero.”

Noble’s procedures changed in April 2013, when the hospital received new equipment and training. At the time, hospital staff “did not recognize the potential risk” that previous patients may have faced, and “the issue was then considered closed,” according to the statement.

It was a Massachusetts Department of Public Health visit to the hospital in late December 2015 that uncovered the lapse and potential risks. The state inspection was prompted by an employee complaint, DPH spokesman Scott Zoback said.

Craft said Baystate officials have seen no indication of similar issues at its other hospitals.

Elsewhere, Cooley Dickinson Hospital in Northampton “takes infection prevention very seriously” and officials are not aware of any reported infections related to colonoscopies, spokeswoman Julia Sorensen wrote in an email.

Disinfection explained

Lawrence Muscarella, a hospital safety consultant in Montgomeryville, Pennsylvania, explained the colonoscope cleaning process this way: The devices typically undergo a multistep disinfection process, which includes being manually cleaned and then run through an automated endoscope reprocesser — essentially “the dishwasher into which you put soiled colonoscopes,” Muscarella said.

The water irrigation channel works like a firehose, Muscarella explained, noting that with a push of a button a stream of water starts washing a mucous membrane off the lower gastrointestinal tract.

Though Muscarella acknowledged that this channel’s purpose differs from those meant to transport body tissue, he dismissed the idea that it is sterile. As it bangs into the walls of the intestine, he said there’s a possibility that fecal matter could make its way inside.

Still, even if a device’s auxiliary water channel is only manually cleaned and not reprocessed, the likelihood that a patients would get an infection is more than just very low, but “remote,” Muscarella said. He said he is more concerned about why patients were not notified sooner, noting that an internal audit could easily have revealed the breach.

“There’s a breakdown that keeps happening,” Muscarella said, noting that the Noble case reminded him of an issue at a hospital outside Pittsburgh several years ago, where patients brought a class-action lawsuit against Forbes Regional Hospital in Monroeville, Pennsylvania, for failing to properly clean colonoscopes.

Other devices

The concern about proper disinfection of hospital equipment is not limited to colonoscopes. Nationally, endoscopes have come under increasing scrutiny in recent years due to concerns about sterilization. Much of the attention has been focused on deadly superbug outbreaks related to CRE, which stands for carbapenem-resistant Enterobacteriaceae.

The Food and Drug Administration warned health care providers in February 2015 about a particular type of medical scope inserted through the throat that could be infecting patients with deadly antibiotic-resistant bacteria. This came after two patients in California died from what hospital officials said were inadequately cleaned devices, The New York Times reported.

“In our situation there has been no cluster of infections,” Haessler said, emphasizing that patients were notified because of the DPH inspection, “not because there had been any evidence of harm.”

A U.S. Sen­ate in­vest­ig­a­tion re­leased earlier this month found 25 out­breaks linked to a device known as a duo­den­o­scope, which is inserted into the mouth, The Los Angeles Times reported.

The device highlighted by the Senate report is different than those used in colonoscopies.

“There has been no clinical indication of the presence of CRE or CRE-related illness associated with colonoscopy at Noble, so we don’t believe there is cause for concern on that front,” Craft wrote in an email.

In early 2015, Baystate Health convened a multidisciplinary team to assess the safety of all its various endoscopes and sterilization processes and this work is ongoing, hospital officials said.

Stephanie McFeeters can be reached at smcfeeters@gazettenet.com.


 


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