According to reports this week, UCLA's Ronald Reagan Medical Center in Los Angeles has potentially infected nearly 180 patients with the "superbug" known as carbapenem-resistant Enterobacteriaceae, or CRE. UCLA has traced the source of the spread to duodenoscopes that are used for endoscopic retrograde cholangiopancreatography (ERCP).

The outbreak was initially discovered last month, and the hospital immediately began notify patients who had been treated as far back as October to offer them medical tests. At least two deaths have been attributed to the current outbreak.

CRE consists of a group of 70 organisms that include Klebsiella pneumonia and Escherichia coli. These bacteria are part of the normal flora of the gastrointestinal tract, but this strain has become resistant to carbapenem. The CRE bacteria contain an enzyme that breaks down the antibiotics, rendering them ineffective.

Although not a new bacteria, it is considered highly fatal, with a mortality rate of 50 percent if it enters the blood stream, therefore increasing the urgency to contain an outbreak. According to CDC Director Tom Frieden, "CRE are nightmare bacteria. Our strongest antibiotics don't work, and patients are left with potentially untreatable infections."

Most healthy individuals will not become infected with CRE, but those with compromised health are particularly vulnerable. Patients are typically infected while in hospitals, nursing homes or other healthcare settings. Currently, 48 states have reported at least one CRE infection — up form 42 states in 2012.

Experts say the spread of CRE is at a critical point if it is to be contained. In 2013, the CDC issued a call to action for all healthcare providers to urgently work together to protect patients from this potentially fatal disease.

Image: CDC

Considering CRE is found predominately in healthcare settings, the spread is thought to be on the hands of personnel and shared equipment, as is suspected in the UCLA outbreak. Strict procedures need to be implemented in order to contain a significant spread.

According to global reports, the use of preventative measures are essential and can reduce the spread. The CDC has developed an extensive toolkit (found here) to aid facilities and regional health departments in managing an outbreak.

This is not the first time an outbreak has occurred in a large hospital setting. Just last year, a large hospital in Seattle reported 32 patients had been contaminated with endoscopes that were carrying CRE bacteria. Eleven of those patients died, however, it was thought that CRE was not the only reason as many of them were already critically ill.

Outbreaks have also occurred in West Virginia in 2011 involving long-term care facilities and at the National Institutes of Health. CRE is not new, but definitely becoming more widespread.

In the UCLA outbreak, the hospital workers reportedly followed recommended sanitizing procedures after each procedure. This has prompted the concern that there needs to be more stringent, modified protocols to insure the equipment is safe. Officials from the FDA, CDC and the equipment manufacturers are collaborating to develop better procedures for cleaning the instruments. This is particularly challenging considering the intricate mechanisms of the scopes.

Unfortunately, this will not be the last we hear of CRE. However, with diligent care, attention and support, it can be contained. It will takes efforts all levels — from individual responsibilities to follow infection control protocols, to facilities being able to identify the organisms promptly, to regional and national support in research and education.

So, remember, wash your hands and follow appropriate infection-control measures. We each have a responsibility in stopping the spread.