Study Shows Bronchoscopes Still Dirty After Reprocessing

A new study has shown that flexible bronchoscopes that were reprocessed according to institutional standards at several US hospitals were still found to be dirty in a majority of the cases. The study was presented at the 2018 Association for Professionals in Infection Control (APIC) Conference.

The study on bronchoscopes now joins other recent studies conducted on colonoscopes and duodenoscopes showing the difficulty in performing high-level disinfection on flexible endoscopes. As this article by Nancy Crotti at Medical Design & Outsourcing explains:

“The results are worrisome as patients undergoing bronchoscopy are commonly at high risk for infection due to transplant status, critical illness, or immune-suppression due to malignancy or chronic disease,” said the study, funded by 3M and supported by sterilization product maker Healthmark Industries. It was presented last week at the Association for Professionals in Infection Control’s annual conference APIC 2018, will be published in an upcoming issue of Chest Journal.

Reusable bronchoscopes are commonly used in interventional pulmonology procedures. They and other reusable endoscopes, including duodenoscopes and colonoscopes, and have been cited in superbug outbreaks in the U.S. and Europe.

The researchers conducted the study at three large hospitals in the United States in 2017, including two transplant centers. They examined 24 clinically used flexible bronchoscopes after they were cleaned and disinfected in accordance with their institutional practices. Contamination was detected using microbial cultures and tests for protein, hemoglobin, and adenosine triphosphate. Reprocessing practices were found to be substandard at two of the three hospitals studied.

After manual cleaning, the researchers found that 100% of the bronchoscopes evaluated had residual contamination. Microbial growth was found in 58% of the fully-reprocessed bronchoscopes, including mold, Stenotrophomonas maltophilia, and Escherichia coli/Shigella spp.

All of the bronchoscopes had visible irregularities, including retained fluid; brown, red, or oily residue; scratches; damaged insertion tubes and distal ends; and filamentous debris in channels. Nursing staff at two of the hospitals were observed handling and transporting patient-ready bronchoscopes with bare hands, potentially exposing the bronchoscopes to contaminants.”

Read the entire article here: Bronchoscopes still dirty after cleaning, study says

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 scope 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 their reprocessing is kept electronically using advanced RFID technology.