A spokesperson from Carolinas HealthCare System-Lincoln (CHS) has confirmed three cases of the “superbug” carbapenem-resistant enterobacteriaceae (CRE) this year. Two of the patients were brought to the hospital with the bacterial infection while a third victim was infected inside the North Carolina hospital.

Decontamination procedures and protocols that go beyond industry standards are being used by staff within CHS to address the infections, including isolating diagnosed CRE patients, using dedicated equipment in the isolation room, performing room cleanings on a daily basis, and having dedicated nursing staff for patients with CRE . The hospital is also actively performing CRE screenings for patients at highest risk. The danger of becoming infected with CRE increases with patients whose care requires devices like ventilators, urinary catheters, or intravenous catheters, and patients who are taking long courses of certain antibiotics. CRE is a family of bacteria usually found in hospitals and other health care facilities that has evolved a huge resistance to antibiotics.

The Centers for Disease Control and Prevention says CRE can kill up to half the patients who become infected. Carbapenem is a class of antibiotics often used as a last resort against a bad bacterial infection, the resistant nature of this bacteria makes the infection difficult to treat.

Previous CRE cases at the UCLA Ronald Reagan Medical Center occured during procedures in which a specialized endoscope is inserted down the throat to diagnose and treat pancreatic and bile duct diseases. The specialized endoscopes, termed duodenoscopes, may have been designed in such a way that impedes proper cleaning of the medical device. An investigation by the FDA is “closely monitoring the association between reprocessed duodenoscopes and the transmission of infectious agents.”

Lincoln County officials said Friday the device is not used at their facility and they said all duodenoscopes they have are disinfected using industry standard methods. Prior to recently published reports about CRE infections resulting from use of this equipment, CHS began to improve its cleaning process by enhancing its current high-level disinfection process by using a “triple wash” process to clean equipment and employing an additional sterilization process on equipment using a gas called Ethylene Oxide. All duodenoscopes that have been tested have shown to be negative for CRE.