Physicians: Dangerous scoped not used locally

Published 3:00 am Saturday, February 28, 2015

Local physicians say the medical scopes cited this week by the FDA as potentially spreading deadly bacteria are not being used in Pike County.

“These warnings apply to a specific scope used by specialists for certain procedures,” said Dr. Rick Gill, a general surgeon in Troy. “These are not done in Troy … the closest places you would see those procedures would be Montgomery or Dothan.”

The U.S. Food and Drug Administration warned this week that the complex design of the duodenoscopes used for specialized ERCP procedures may impeded effective cleaning, therefore increasing the risk of bacterial cross-contamination.

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The warning came after the University of California reported infecting seven people during procedures using the scopes and notified nearly 180 patients that they may have been infected with the carbapenem-resistant Enterobacteriaceae, or CRE – the latest and most difficult to treat in a series of superbugs that includes MRSA and VRA. Two of the seven infected patients have died.

“TRMC is warning the public to be cautious when interpreting this type of headline news concerning health care,” said Dr. Paul Dulaney, TRMC chief of staff. “The latest warning issued by the FDA concerns a specific endoscopic procedure which uses a complex designed endoscope …

“The design of this scope is rather complex, making it more difficult to sterilize and thus posses a small but clinically significant higher rate of cross-contamination.”

Endoscopy is a procedure used to examine the digestive tract. Using an endoscope – a flexible tube with a light and camera attached to it – doctors view pictures of the tract on a TV monitor.

Common procedures include upper endoscopy (EGD), which views the upper GI tract, the esophagus, the stomach and the dueodenum, and lower endoscopy, which views the lower digestive tract, the rectum and the colon.

Endoscopies typically are performed by a general surgeon such as Gill, who said he performs about 30 per week.

Gill said the scopes in question are used during endoscopic retrograde cholangiopancreatography (ERCP), a specialized procedure conducted by gastroenterologists that often involves draining fluids from pancreatic and billary ducts. The scope in question is tiny, less than a centimeter, and is angularly shaped. That angular shape is what impedes the ability to effectively clean the scope and could lead to cross contamination, the FDA said.

“It’s important to understand that we don’t do these procedures here in Troy,” Gill said.

Moreover, TRMC uses the newest FDA guidelines in cleaning and sterilizing its equipment. “We use a two-step process where the scopes are cleaned manually and then machine cleaned,” Gill said, explaining that the scopes are soaked and each individual channel is cleaned with a brush before being hooked to a reprocessing machine for internal sterilization.

“The sterilization techniques that are used (at TRMC) are the gold standard and their efficacy is well-document,” Dulaney said. “Therefore you can be confident that contamination related to endoscopic procedures performed at TRMC is not an issue.”

Experts have said the increase in treatment-resistant “superbugs” such as CRE or MRSA are a result of the misuse of antibiotics over many decades. National attention to the issue has sparked increased awareness among patients.

“I’m seeing that more patients are taking personal ownership of their health care,” Gill said. “They are now asking questions – which is the right thing to do? Is this the best way to do it? – and they are looking at the ramifications of taking medicine (such as antibiotics).”

Dulaney said TRMC is equally focused on minimizing the risk of infection for its patients. “Any infection related to any procedure performed is traced and vetted to ensure it was not related to the equipment used or the personnel involved in the case,” he said. “These statistics are reported as National Incident Management systems or NIMS. WE take great pride in our NIMs rate being significantly lower than national average and we will continue to maintain our excellent rating.”