Dr. Muscarella’s following comments and perspectives are in reply to HLN-TV’s recent article:

Dr. Drew responds to ‘superbug’ health scare | HLNtv.com  (March 9, 2015)

HLN-TV (a national television network) reports that: “First it was Ebola inciting fear and panic, now it’s a dreaded so-called ‘superbug.'”

This TV-news source adds: “Two top hospitals in Los Angeles and one in Hartford, Connecticut are making headlines because of medical equipment that was infected with CRE, also known as carbapenem-resistant Enterobacteriaceae.”

Also according to HLN-TV: “Dr. Drew insists: the ‘superbug’ isn’t a new phenomenon, and the attention that it’s getting is inciting unnecessary panic.  There is always a risk that certain bacteria will be resistant to cleaning.”


First, actually, No. It is not that “superbugs” and other deadly bacteria are resistant to cleaning, per se.

Rather, according to the Food and Drug Administration (FDA), it is the physical design of a specialized type of gastrointestinal (GI) endoscope — known as a side-viewing duodenoscope, or ERCP endoscope (which is used to perform endoscopic retrograde cholangiopancreatography) — that can hinder direct access to, and the thorough cleaning and mechanical brushing of, all of its potentially contaminated surfaces.

The FDA writes on February 19, 2015, in its published safety alert entitled “Design of Endoscopic Retrograde Cholangiopancreatography (ERCP) Duodenoscopes May Impede Effective Cleaning: FDA Safety Communication” that:

“the complex design of ERCP endoscopes (also called duodenoscopes) may impede effective reprocessing. Reprocessing is a detailed, multistep process to clean and disinfect or sterilize reusable devices.” — FDA.

Dr. Drew, this clarification presents a significant difference with a crucial distinction.

For more information about the risk of superbug infections during GI endoscopy, consider reading any one of my several peer-reviewed articles on this topic, two of which are provided in the reference section, below, for your convenience.

Legal Reviews and Reports for Hospitals, Manufacturers, Patients:  Click here to read about Dr. Muscarella’s expertise and legal assessments of the causes of healthcare-associated infections, including “superbug” outbreaks linked to contaminated GI endoscopes and other reusable medical equipment.

Second, certainly and respectfully, the transmission of deadly superbugs by way of  contaminated ERCP endoscopes, which — despite (according to the FDA) hospital staffers cleaning and disinfecting these complex instruments in strict compliance with the instructions not only provided by the manufacturers (including Olympus), but also overseen and regulated by the FDA — is a relatively new phenomenon whose repeat act is not welcomed.

Third, provided in this blog — click here is the most complete series of articles discussing the several recent “superbug” outbreaks around the U.S., including those in Los Angeles (CA), Seattle (WA), Philadelphia (PA) and Highlands County (FL), to name a few.

Moreover, this list provides some of the news sources that have reported on this topic and quoted hospital officials and safety experts including myself about these superbug outbreaks, their causes, and what can be done to prevent their recurrence in U.S. hospitals.

No panic

Such efforts as displayed in the blog and in most press reports including articles in USA Today, The Seattle Times, Bloomberg Business, and The Los Angeles Times are intended to do exactly that which you sternly countenance: to educate the public and to allay, not incite, panic.

To be sure, panic is not a term expressed in the current lexicon of these discussions. To the best of my knowledge, not one news report or quote attributed to an interviewed expert has sought to irresponsibly incite alarm or panic. Please correct me, Sir, if I am wrong.

Instead, circumspection is advised

As NPR Radio in Los Angeles recently quoted me as saying: Panic is not in play.

Instead, the public should remain cautiously concerned and abreast of all of the facts surrounding recent revelations by the FDA that, not bacteria resistant to cleaning, but the designs of these specialized reusable devices — one of which is used in many U.S. hospitals even though, to date, it has not been cleared by the FDA for such use (i.e., the Olympus TJF-Q180V side-viewing duodenoscope) — have been identified as a cause of these several recent superbug outbreaks across the U.S.

Stay tuned, Dr. Drew, there may be more heavy shoes to fall.

Contact:  Email Dr. Muscarella at Larry@LFM-HCS.com with your questions or comments.


  • Muscarella LF. Risk of transmission of carbapenem-resistant Enterobacteriaceae (CRE) and related ‘superbugs’ during gastrointestinal endoscopy” World Journal of Gastrointestinal Endoscopy 2014 Oct 16;6(10):457-74 — click here.
  • Muscarella LF. Investigation and prevention of infectious outbreaks during endoscopic retrograde cholangiopancreatography” Endoscopy 2010 Nov;42(11):957-9 — click here.

Posted: 3/10/2015, Rev C.

Leave a Reply

Your email address will not be published.