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Deadly superbugs from hospitals get
stronger in the sewers and could end up
in the Pacific Ocean
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A worker at L.A.'s Hyperion sewage treatment facility removes trash that has been separated from incoming
wastewater. (Gary Friedman/Los Angeles Times)
LeM Petersen Contaet Reporter
March 9,2016
Every day Southern California hospitals unleash millions of gallons of raw sewage into
municipal sewers.
The malodorous muck flows miles to one of the region's sewage plants,where it is treated with
the rest of the area's waste and then released as clear water into a stream or directly to the Pacific.
Scientists at the Environmental Protection Aeencv recently announced they had discovered a
lethal superbug—the same one that caused outbreaks at UCLA and two other Los Angeles-area
hospitals—in sewage at one of those plants.They declined to name the facility.
EPA scientists did not test treated wastewater flowing out of the plant to determine whether it
still contained CRE or carbapenem-resistant enterobacteriaceae.
But a growing number of studies show sewage plants can't kill the superbugs. Instead the
facilities serve as "a luxury hotel" for drug-resistant bacteria,a place where they thrive and grow
stronger, said Pedro Alvarez, a professor of environmental engineering at Rice University, one of
the scientists studying the problem.
Alvarez and other researchers say the failure of sewage plants to eliminate the dangerous bacteria
is one way they may be spreading from hospitals to the environment.
sewage sources
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"Chlorine is just not doing it," Alvarez said of the treatment used by most plants.
The fear is that healthy people otherwise not at risk from the bacteria including swimmers at
the beach—could be infected.
Already officials are worried about the surprising number of people sickened with CRE who
have not recently visited a medical facility: 8%,according to an October study.
Hospitals are not breaking laws by releasing the sewage. Laws regulate the overall level of
disease-causing bacteria in the nation's surface waters,but there is no specific regulation of
bacteria resistant to antibiotics.
Deemed the "nightmare bacteria"by federal officials, CRE survives nearly all antibiotics. It kills
as many as half its victims.
Government officials,including those at the federal Centers for Disease Control and Prevention,
say they are monitoring the wastewater studies but have so far made no recommendations to
hospitals about the treatment of sewage that may harbor CRE.
"The prevention and control of CRE is an evolving process," said Melissa Brower, an agency
spokeswoman. "CDC will continue to assess the appropriateness of this as new information
becomes available."
Researchers have tried for years to raise the alarm about hospital sewage. The sludge includes
not just waste from patients suffering from drug-resistant infections but also high levels of
antibiotics prescribed to treat them.
As the sewage mixes,the antibiotics kill off weaker bacteria,leaving the more lethal ones to
thrive. The bugs reproduce rapidly,and different species can swap genes,transferring their
ability to withstand the drugs.
Last year,the nation's treatment plants were alerted to the risks of untreated medical sewage
when a few American hospitals began caring for patients who had been struck by Ebola in
Africa.
The CDC directed hospitals to allow the Ebola patients to use the toilets in their rooms,but said
sewer workers should wear protective clothing,including goggles and a face mask,to protect
themselves from the highly contagious virus.
Concern about that case prompted a foundation supported by water utilities to study what
contaminants,including bacteria,hospitals are releasing in sewage.
"The idea of CRE flowing down our sewer pipes gets me nervous," said Dr.James McKinnell,
an infectious disease expert at the Los Angeles Biomedical Research Institute, who has been
working to stop superbugs from spreading. "We should be testing our runoff."
Inside hospitals,staff go on high alert when a patient tests positive for CRE.
Infected patients are isolated.Nmses don protective gowns and gloves. Family and friends are
warned about visiting.
So far at least 75 of the 100 hospitals in Los Angeles, Orange and Ventura counties have
reported patients infected with CRE.Los Angeles has the state's highest rate.
CRE thrives in water.Hospitals have found it living in sink drains.The bacteria are happy in
patients' intestines and it passes through in urine and waste.
Every day,2 million gallons of raw sewage from Los Angeles hospitals flows to the city's
Hyperion treatment facility.
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A number of U.S. hospitals have experienced bacterial outbreaks relater,'to contaminated medical
scopes, including at UCLA's Ronald Reagan Medical Center and Cedars-Sinai hospital.
The Disneyland-sized complex of pipes, giant tanks and pools sits at the edge of the Pacific,near
Los Angeles International Airport.
Like other plants,Hyperion intentionally creates an ideal environment for microorganisms to
thrive. The plant mixes non-disease-causing bacteria into the sewage and pumps in oxygen,
allowing the bugs to feed and break down the waste.
The solids are settled out,and the clear water is piped five miles offshore and released 190 feet
below the waves. It is treated with chlorine only in rare cases when it is released a mile offshore.
Hyperion employees test the treated water for levels of bacteria,but do not hunt for those that
resist antibiotics like CRE. -
Timeyin Dafeta,Hyperion's manager, said that if CRE was present it "would be in extremely low
concentrations"because hospital sewage accounts for just 0.5%of the city's wastewater.
"We have no indication the effluent is coming back to impact the shoreline,"Dafem said.
Farther south,dozens of other sewage plants release treated wastewater into creeks and concrete
channels that eventually flow into the Pacific.
Some surf spots—like the Santa Ana River jetties in Orange County—have become known as
places with great waves that can make you sick.
"Just check yourself for cuts prior to entering,"the surfing magazine Stab recently warned about
the site on the northern border of Newport Beach. "Oh,and keep your mouth shut."
California officials don't know what bacteria is in the seawater. They monitor the ocean water for
what they call fecal indicator bacteria—a sign of raw sewage. But they rarely test for specific
bacteria,including those that are drug-resistant.
A 2010 study estimated that 689,000 to 4 million people are struck by gastrointestinal illnesses
caught from Southern California beaches each year. An additional 693,000 are sickened with
respiratory problems.
In December 2014, Barry Ault died on Christmas morning a few days after surfing off Sunset
Cliffs in San Diego.A staph infection attacked the 71-year-old's heart valve,which had been
replaced 10 months before.
Ault's friend also got seriously ill. The two went surfing just after a rainstorm when its not
possible for sewage treatment plants to handle all the runoff.
Sally Ault,Barry's wife,said that the two were surfing in an area known for not being polluted.
She said her husband,who grew up in Arcadia,had fully recovered from the earlier heart
operation and was in great shape.
"It was nothing other than the bacteria," she said.
It's difficult to find which regulatory agency is responsible for monitoring what hospitals release
to the sewers.
The state public health department referred questions to State Water Resources Control Board
officials. That agency referred questions to county officials,who said they had made no
recommendations to hospitals to pre-treat sewage from CRE patients.
Enrique Rivera,a spokesman for UCLA,where three patients died after being infected by CRE
from a contaminated medical scope, said that no one was available to comment.
A spokesman at Cedars-Sinai,site of a similar scope-linked outbreak, said the hospital follows
all regulations relating to the handling of patient waste.
Cathy Milboum at the EPA said agency scientists believe there is "insufficient information
available to reach a definite conclusion on the presence and fate" of drug-resistant bacteria in
sewage plants.
Last fall, a team of EPA scientists reported that they had found CRE in sewage at treatment
plants across the country—including one in Southern California and another in the northern part
of the state.
"I tested seven different plants and I found it in all of them,"said Jill Hoelle,a scientist in the
EPA's office of research and development.
The scientists concluded that CRE is "widespread" in America's sewage—a finding that Hoelle
said she found surprising given that reported patient infections are still relatively rare.
Alvarez,the Rice professor,said that with the rise of ever more dangerous bacteria like CRE,
there is a risk of returning to a time,before the invention of water treatment,when infectious
diseases were a major cause of death.
"We can save more lives by treating water than doctors can,"he said.
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