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Endoscope 'disinfection failure' linked to nine NDM cases in UK

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Nine people were infected with bacteria carrying the New Delhi metallo-beta-lactamase (NDM) enzyme after “disinfection failure” with a single endoscope camera at a UK hospital, a document obtained by Nursing Times reveals.

NDM causes bacteria to become antibiotic resistant and was last month linked to the death of five patients in the UK.

The newly unearthed report by the Health Protection Agency’s director of antibiotic resistance monitoring Dr David Livermore says there were 59 cases of NDM in UK by September this year.

The spread of NDM has been linked to patients who have received surgery in the Indian sub continent – a link strenuously denied by some hospitals from that region.

Commenting on the spread of the infection in the UK, the report says that although links with the Indian sub-continent “remain strong”, “there has been a UK-based series of nine cases linked to disinfection failure with an endoscope camera”.

The HPA report was released to Nursing Times under the Freedom of Information Act. The HPA have confirmed the infected camera was used at Shrewsbury and Telford Hospital NHS Trust in the West Midlands. All the patients involved survived.

Endoscopes are used to examine patients internally and are usually inserted through a bodily cavity such as the anus or throat.

Infection Prevention Society president Tracey Cooper said: “Endoscopes are complex pieces of equipment, that’s why there are evidence-based national standards for their decontamination. These and other decontamination standards get reviewed regularly.”

The HPA report also said there were two hospitals in north-west England with high numbers of Klebsiella Pneumoniae Carbapenemase (KPC) infection – which can be associated with NDM.

It says of the cases: “Many are recent and from one hospital in the North West. A single plasmid seems to be circulating around multiple wards.” It adds they seem to have been found mainly in pneumonia strains but also in E coli and Enterobacter bacteria.

Dr Livermore’s  report adds that the cluster of KPC cases at the other North West hospital is being investigated for a possible link to local care homes.

In August, research published in the medical journal The Lancet called NDM a “potentially a major global health problem”.

Shrewsbury and Telford Hospital Trust’s director of infection prevention and control Patricia O’Neill said in a statement: “Earlier this summer we identified a small cluster of patients with urine infections caused by an antibiotic resistant bacteria called Klebsiella.

“These nine patients had recently undergone rigid cystoscopy (bladder examination) at the Princess Royal Hospital. In general the symptoms have either been mild or non-symptomatic but two patients have required intravenous antibiotics.

“This infection was spotted because of high standards of infection control in our hospitals, and through support from the Health Protection Agency. At the trust we have a very strong record for tackling these infections.”

 

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Readers' comments (1)

  • To reduce any potential confusion for patients, this article refers to the cluster of NDM-1 Klebsiella infections that was first reported in the press in July. The source of cross infection was quickly identified and addressed and there have been no recurrences.

    Further information is available from the Trust's website at www.sath.nhs.uk where you will see a link to the Trust's Klebsiella Update from September on the news menu on the right hand side of the page.

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