Infection Outbreak Linked to Hospital Tap Water
Tap Water WATER DANGERS Bacteria found in hospital tap water allegedly infected 27 patients.

Health officials are trying to determine how a bacteria found in the regular tap water supply infected 27 women who underwent surgery at a Charleston, S.C., hospital in 2016 and 2017.

The tap water at Roper Hospital tested positive for non-tuberculous mycobacteria, but hospital officials can't explain how surgical patients were exposed to bacteria found in the regular tap water supply.

Most of the infected patients underwent breast reconstruction surgery. They required additional surgery and months of antibiotic treatment to treat the infection.

A lawsuit filed on behalf of one of the patients also alleges several lapses in infection control practices during procedures, including improper changing of gloves, uncovered hair and non-scrubbed visitors standing too close to the sterile field.

Roper Hospital did not respond to a request for comment.

Richard Abowitz

Can Endoscopes Be Cleaned?
Cleaning Endoscopic VESTED INTEREST Dr. Max Lehfeldt was allegedly on Allergan's payroll to promote and research the company's SERI surgical scaffold system.

The channels of flexible endoscopes can harbor microbial growth and residual water even when proper reprocessing practices are followed, according to a pair of new studies, which question if enough is being done to protect patients from infections associated with these notoriously difficult-to-clean devices.

The first study, published in the American Journal of Infection Control, assessed the endoscope reprocessing, drying and storage practices in use at 3 U.S. hospitals. Visual examinations and testing designed to detect fluid and contamination in 45 reprocessed scopes revealed 49% of the devices' channels contained moisture and 71% showed traces of microbial growth. High adenosine triphosphate (ATP) levels mdash; which indicate actively growing microorganisms — were found in 22% of scopes, according to the study, which notes scopes with retained water were more likely to show signs of microbial growth.

Staff at only one of the hospitals followed proper reprocessing and drying practices, say the researchers, who point out endoscope reprocessing failed about half the time, even in the hospital where staff complied with scope handling guidelines. The researchers found a high correlation between readings on quick-check moisture indication strips and more time-consuming visual inspections of endoscope channels for residual fluid. Moisture indicator strips are therefore an inexpensive and practical way to check reprocessed scopes for left-behind fluid, according to the study's authors.

The second study, published in the journal Gut, identified contaminated duodenoscopes in 39% of 73 Dutch facilities that perform endoscopic retrograde cholangiopancreatography (ERCP). Overall, 23 of 150 scopes made by Olympus, Pentax or Fujifilm were contaminated with microorganisms originating from the gastrointestinal tract, which indicates organic matter from previous patients was still present after reprocessing.

Contamination occurred in all duodenoscopes, regardless of type and design, according to the researchers. They say current reprocessing protocols are inadequate and unsafe, and call for scope redesigns and increased microbial surveillance to limit the number of contaminated scopes that continually put patients at risk of potentially life-threatening infections.

Daniel Cook

What If Opioids Prolong Pain After Surgery?
Opioids NOT TRUE Ex surgeon says the Seattle Times ruined his reputation by falsely reporting he was paid by volume and conducted concurrent surgeries.

What if the opioids patients take after surgery lead to chronic pain? That's a question researchers are asking after their study in Anesthesia and Analgesia found that rats given morphine felt pain for 3 weeks longer than rats given no opiates after surgery.

In one experiment, researchers at the University of Colorado Boulder performed laparotomies on rats. They gave half the rats morphine for 7 days postsurgery and half a saline solution. All the rats that received morphine experienced pain — based on their sensitivity to touch — for more than 3 weeks after surgery than the rats that received saline.

Other experiments in which rats were given morphine for 8 days (tapered off for 2 more days) and 10 days (dose abruptly discontinued) showed similar results — the morphine rats felt post-op pain for more than 3 weeks longer, and the longer they received morphine, the longer their pain lasted. Gradual tapering made no difference.

"This indicates that there is another dark side of opiates that many people don't suspect," says senior author Linda Watkins, PhD, a professor in the department of psychology and neuroscience at University of Colorado Boulder. "It shows that trauma, including surgery, in combination with opiates can lead to chronic pain."

JoEllen McBride, PhD

InstaPoll: Wedding Bands in the OR

What's your policy for staff wearing wedding rings in the operating room? Tell us in this week's InstaPoll.

Last week's poll results indicate it's not unheard of to have to cancel a case due to missing instruments. Here's what our 331 respondents had to say:

Ever cancel a case because of missing instruments?

  • often 2%
  • sometimes 6%
  • occasionally 15%
  • seldom 46%
  • never 31%

Dan O'Connor

News & Notes
  • FDA warns of risk from 24-hour multi-patient endoscope connectors The FDA issued a warning to health care providers against using 24-hour multi-patient use endoscope connectors. Created for use with multiple patients without reprocessing and sold under the name ERBEFLO, this port connector, the FDA claims, "does not include a backflow prevention feature." As a result, there is a risk of cross contamination with "blood, stool, or other fluids from previous patients that travel back through the endoscope channels into the connector." Instead the FDA recommends backflow prevention through connectors designed either for single use or to be reprocessed between patients.
  • Reduce risks of workplace violence The Joint Commission's new Sentinel Event Alert aims to reduce the risk of physical and verbal violence against healthcare workers, who are 4 times more likely than employees in other professions to be victimized by a host of threats, ranging from daily bullying to active shooters. The alert outlines ways to recognize and reduce the risk of contributing factors of workplace violence and properly manage the aftermath of events that do occur.
  • Pennsylvania's proposed ASC taxA proposal in Pennsylvania's 2018-2019 state budget would add a 2.81% tax on ASCs in the state to provide additional funding for the state's Medicaid program. A coalition of 17 state medical societies came out against the tax hike in a letter to all state legislators saying each ASC would have to pay approximately $100,000 more in taxes each year, which could force some to reduce services or close altogether.