Hospital Policy Eyed in L.A. Outbreak

The Associated Press
Thursday, December 21, 2006; 7:44 PM

LOS ANGELES -- 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.

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