Study Reveals Bronchoscopes Ready For Use On Patients Are Still Dirty
Several recent studies have shown that despite best efforts to follow manufacturer reprocessing guidelines, bronchoscopes deemed ready for patient use are still contaminated at a high rate. Some of the most recent research highlighting the difficulties of disinfecting bronchoscopes was published by Cori Ofstead, MSPH.
In a recent presentation at the annual meeting of the Association of Professionals in Infection Control and Epidemiology (APIC), Ms. Ofstead discussed some of her recent findings. In a recent study, researchers found that 100% of the bronchoscopes evaluated had residual contamination after manual cleaning. Microbial growth was found in 58% of fully-reprocessed bronchoscopes, including mold, Stenotrophomonas maltophilia, and Escherichia coli/Shigella spp. This article by Kelly M. Pyrek at Infection Control Today discusses the inherent risks associated with bronchoscopes:
“In her presentation at APIC, Ofstead emphasized the continuance of breaches in protocols. “In theory and accordance with the IFUs, bronchoscopes are supposed to be reprocessed starting immediately after use; and the first thing that is supposed to happen is a bedside pre-cleaning as soon as that bronchoscope comes out of the patient’s body,” Ofstead says. “When that’s done, they should be transported to a reprocessing area where they would undergo a leak test and then they would be thoroughly cleaned and rinsed off. After that, they are supposed to get a visual inspection to make sure that you got all the gunk off, and that is supposed to be performed with lighted magnification. The guidelines from AAMI and AORN now recommend that there also be biological testing for cleaning verification, so because the scope is black and you can’t see inside of it, you must do something to make sure that the cleaning you did in the dark, so to speak, actually worked. Once you verify that it is clean, and if it’s not clean, you clean it again, then it would either be sterilized or high-level disinfected and dried before storage. In some of the guidelines it is also specified that it should get a visual inspection right before use. I caution people that we often boil down the steps into this short, compact list that sounds easy but what we know when we go in to perform audits there are numerous steps when following the guidelines and depending on the scope, there might be 100 to 140 steps they must do and they generally must do them in an order that is specific. So, it’s a lot to remember.”
Kovaleva (2015) reminds us of the risks associated with bronchoscopy; she writes, “The exogenous microorganisms most frequently associated with transmission of infection during bronchoscopy are Pseudomonas aeruginosa and mycobacteria. These microorganisms can be transmitted from previous patients or contaminated reprocessing equipment by contaminated endoscopes or accessory equipment. Exogenous infection should be prevented by strict endoscope disinfection procedures. During the period 1970-2012, 48 outbreaks of exogenous bronchoscopy-related infections and cross-contaminations involving 198 infected patients were reported in the literature. Several outbreaks of bronchoscopy-related transmission of multidrug-resistant P. aeruginosa and carbapenemase-producing Klebsiella pneumoniae have been published during the past few years.”
…Kovaleva (2015) adds, “Modern bronchoscopes contain multiple channels and ports which are difficult to clean and disinfect and allow for the collection of organic material and the forming of biofilms. A biofilm is an assemblage of microbial cells attached to a surface and enclosed in a matrix of exopolymeric substances. Biofilms are extremely difficult to remove, show increased resistance to disinfectants and antibiotics and can result in failure of reprocessing of endoscopes and outbreaks of endoscopy-related infections. Two outbreaks of bronchoscopy-related infection and cross-contamination of P. aeruginosa, Mycobacterium chelonae and Methylobacterium mesophilicum involving 28 patients were attributed to contaminated AERs with the presence of biofilm deposits on the internal plumbing.”
Kovaleva (2015) acknowledges that routine microbiological testing for endoscopes and AERs remains a controversial issue in many guidelines: “Microbiological surveillance of endoscope reprocessing has been recommended by several medical specialist organizations but there are no standards for the frequency of testing intervals of surveillance cultures. It is appropriate to trace contaminations of endoscopes and to prevent contaminations and infections in patients after endoscopic procedures. The use of environmental endoscope culturing is a rapid and simple method to monitor the effectiveness of standard reprocessing procedures. Contaminated bronchoscopes have been linked to many outbreaks of device-related nosocomial infections. The true incidence of bronchoscopy-related infections is unknown because of inadequate surveillance or no surveillance at all. Endoscopy-related infections can cause serious harm and can give rise to concerns over these procedures by physicians and patients. A continuous search for ways to improve the disinfection process and to construct such endoscopes that the risk of biofilm formation will be reduced, remains warranted.””
Read the entire article here: Device-Related Infections: Patient-Ready Bronchoscopes Found to be Contaminated Despite Cleaning and Disinfection
The infection risk with bronchoscopes and all flexible endoscopes continues to be a major worry for hospitals. Facilities must ensure staff are trained on general infection control principles and must adhere to reprocessing best practices. To ensure that your staff is following reprocessing best practices on every bronchoscope, colonoscope and other flexible endoscope they disinfect, install additional checks and balances into your workflow so that you can document that your staff is following the same process each time. Software systems such as iRIScope have been introduced in recent years to help hospitals and surgery centers ensure that each of their flexible endoscopes is reprocessed the proper way each time, and documentation of each step of the reprocessing cycle is kept electronically using advanced RFID technology.