Most hospitals aren't required to report superbug outbreaks. Should they be?

Just 20 states have rules requiring disclosure of CRE outbreaks

Recent superbug outbreaks linked to specialized endoscopes have prompted calls for mandatory national reporting requirements for the diseases, the Los Angeles Times reports.

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Details of the recent outbreaks

FDA last month issued a general warning to hospitals over the design of duodenoscopes, noting that they are difficult to clean and can "facilitate the spread of deadly bacteria." The devices have been linked to several outbreaks of antibiotic-resistant disease. For example:

  • An outbreak at the University of California-Los Angeles' (UCLA) Ronald Reagan Medical Center between October 2014 and January 2015 has California health officials working to track down as many as 179 patients who could have been exposed to Carbapenem-Resistant Enterobacteriaceae (CRE) after having an endoscopic retrograde cholangiopancreatography (ERC). CRE bacteria are resistant to most antibiotics, and FDA data show that they kill up to 50% of individuals with bloodstream infection.
  • Earlier this year, a hospital in Seattle reported that as many as 11 deaths at the facility may have been linked to CRE spread through duodenoscopes.
  • Last week, Cedars-Sinai Medical Center reported that four patients had been infected with CRE after being exposed to a contaminated scope.
  • Also last week, Hartford Hospital reported that 281 patients may have been exposed to antibiotic-resistant E. coli through contaminated duodenoscopes.

FDA said it is working with CDC on looking at other steps that can be taken to reduce infection risks. But the agency said that it was not recommending that providers cancel necessary procedures performed with duodenoscopes.

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Details of call for reporting requirements

Federal regulations require hospitals to report their rates of six types of infections, but CRE is not one of them. Meanwhile, states have the authority to require hospitals to report CRE infections, but just 20 states have implemented such requirements.

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The recent outbreaks have prompted lawmakers and other stakeholders to call for mandatory reporting of CRE infections. Peter Mendel, a researcher and expert on infection reporting at Santa Monica-based Rand Corporation, says, "It's important to know what's out there, because these are serious infections. You shouldn't wait until there's an outbreak."

Similarly, Consumers Union's Lisa McGiffert says hospitals should inform prospective patients when they discover a superbug outbreak, and public health authorities should ensure that the message reaches the public. She argues that the existing system creates "a secret network" that contributes to the spread of illnesses.

Rep. Ted Lieu (D-Calif.) has announced plans to introduce a bill that will aim to require hospitals to report CRE cases to CDC. Lieu says, "I don't see how we can combat superbugs if the CDC doesn't even know the full scope of the problem," adding, "We should have uniform national reporting for all hospitals."

According to a CDC spokesperson, such requirements generally are made at the state level. "[U]ltimately, the decision should be based on what makes sense for prevention in a particular state," the spokesperson said.

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Meanwhile, experts say there are other methods for controlling the infection. For instance, a state-run registry of patients with CRE in Illinois helps providers determine when a patient requires isolation or other precautions. Health officials also could periodically examine hospital lab data for CRE cases.

The American Hospital Association (AHA) is asking hospitals to be transparent with patients. "We encourage all hospitals to be transparent in the case of a contagion, proactively communicating with all possibly impacted patients, informing them the potential for infection, and offering follow-up care and treatment," says AHA CMO John Combes (Terhune, Los Angeles Times, 3/6; Tozzi, Bloomberg, 3/6).

The takeaway: Although there are no federal regulations requiring hospitals to publicly disclose CRE infections, health experts encourage hospitals to do so proactively to ensure that any affected patients receive appropriate and timely follow-up care.

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