AP News, December 22nd, 2006
The recent deaths of two premature babies at a hospital linked to an outbreak of a common bacterium raise questions about whether officials took the necessary precautions to prevent the spread of the hardy germ.
A preliminary investigation by the Los Angeles County Department of Public Health traced the fatal outbreak at White Memorial Medical Center to contaminated laryngoscope blades, a type of medical instrument used to look inside a patient's mouth.
White Memorial closed off its neonatal intensive care unit Dec. 4 following the outbreak of Pseudomonas aeruginosa that sickened five infants. Officials believe the subsequent deaths of two of the babies may be linked to the pathogen, which is a common but potentially deadly bacterium, particularly to people with weak immune systems.
Of the roughly two million hospital-acquired infections each year, about 10 percent are caused by P. aeruginosa. The germ can be spread by health care workers, medical instruments, disinfectant solutions and food.
Until earlier this year, cleansing of laryngoscope blades had been done by White Memorial's in-house sterilization department, which subjected the devices to high-level disinfection as required by the manufacturer.
Then the practice was abruptly changed and cleaning was handled by the respiratory therapy staff instead. It's unknown whether the respiratory staff followed proper cleaning procedures. White Memorial has since returned to having the blades cleaned by specialized technicians.
Disease control experts, who noticed the change in cleaning procedure, said they were still awaiting an explanation by the hospital.
"We know they had deviated from that policy, but we're not sure how," said Dr. Laurene Mascola, the director of the county's acute communicable disease control unit.
While it's not unheard of for hospital staff to clean medical instruments themselves, lapses can occur if the cleaning is not done according to the manufacturer's instructions, say medical experts.
"If they were just wiping them down, it would be a breach of sterility," said Dr. Gerald Berke, chief of head and neck surgery at the David Geffen School of Medicine at the University of California, Los Angeles.
The outbreak at White Memorial, which serves mostly minority patients, forced it to close its neonatal and pediatric wards two weeks ago to new patients. Both units were reopened this week after hospital officials assured the community that the outbreak was contained.
Hospital-acquired infections cause about 90,000 deaths and $4.5 billion in health care costs annually, according to the federal Centers for Disease Control and Prevention.
Reporting of Pseudomonas outbreaks varies by state and the CDC does not keep national statistics on the prevalence of the bacterium, said agency spokeswoman Jennifer Marcone.
In light of past deadly outbreaks, hospitals nationwide typically take strict precautions such as disinfecting medical equipment and tabletops to prevent the spread of the bacterium.
"At the current time, there is no way to completely prevent Pseudomonas infections because the organism is so ubiquitous," said Dr. Joseph Bocchini, chief of pediatric infectious diseases at Louisiana State University Health Sciences Center.
Dr. Rosalio Lopez, the chief medical officer at White Memorial, has declined to comment on the hospital cleaning policy, citing the ongoing investigation. He also refused to name the maker of the laryngoscope blades used by the hospital.
Since the outbreak was made public on Dec. 15, Lopez has repeatedly apologized to the families. David Marin, whose infant son died on Monday, plans to file a wrongful death lawsuit against White Memorial.
Lopez insisted the hospital informed patients and public health officials about the outbreak in a timely manner and has since stepped up their policing by requiring nurses to wear protective coverings when caring for infants and re-educating the staff about infection control policies.
It's not the first time a Pseudomonas outbreak has been linked to contaminated equipment. In 2002, 16 patients at Allegheny General Hospital in Pennsylvania were exposed to Pseudomonas through bronchoscopes that weren't properly sterilized. The flexible devices are used to look into the lungs of seriously ill patients.
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On the Net:
White Memorial Medical Center: http://www.whitememorial.com
Los Angeles County Department of Public Health: http://www.lapublichealth.org
