Semin Respir Crit Care Med 2004; 25(4): 443-449
DOI: 10.1055/s-2004-832717
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Reprocessing the Bronchoscope: The Challenges

Majid M. Mughal1 , Omar A. Minai1 , Daniel A. Culver1 , Atul C. Mehta1
  • 1Department of Pulmonary and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio
Further Information

Publication History

Publication Date:
30 August 2004 (online)

Spread of infection through the flexible bronchoscope is underrecognized and underreported. Prevention of bronchoscopy-induced infection requires increased vigilance by the physician, assiduous implementation of reprocessing protocols, and closer collaboration between bronchoscopy personnel, infection control practitioners, and instrument manufacturers. Patient safety depends on adequate disinfection of bronchoscopes and accessories used, as well as proper training of bronchoscopists, nurses, and ancillary staff. It is important to recognize that microbial transmission may occur via any part of instruments or anything in contact with the instruments including cleaning solutions, automated washers, and rinsing water. Numerous surveys have suggested poor adherence to published preventive guidelines. To address the challenges of reprocessing bronchoscopes, all users must comply with guidelines for cleaning and disinfection and each procedure should be performed with a clean, disinfected bronchoscope.

REFERENCES

  • 1 Rutala W A. APIC guidelines for selection and use of disinfectants.  Am J Infect Control. 1996;  24 313-342
  • 2 Rutala W A. Disinfection, sterilization and waste disposal. In: Wenzel RP Prevention and Control of Nosocomial Infections. 2nd ed Baltimore; Williams and Wilkins 1993: 460-495
  • 3 Kirshke D L, Jones T F, Craig A S et al.. Pseudomonas aeruginosa and Serratia marcesens contamination associated with a manufacturing defect in bronchoscopes.  N Engl J Med. 2003;  348 214-220
  • 4 Srinivasan A, Wolfenden L L, Song X et al.. An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes.  N Engl J Med. 2003;  348 221-227
  • 5 Cetre J C, Salord H, Vanhems P et al.. Outbreaks of infection associated with bronchoscopes.  N Engl J Med. 2003;  348 2039-2040
  • 6 Spaulding E H, Cundy K R, Turner F J. Chemical disinfection of medical and surgical supplies. In: Block SS Disinfection, Sterilization and Preservation. 2nd ed Philadelphia; Lea & Febiger 1977: 654-684
  • 7 Spaulding E H, Groschel D HM. Hospital disinfectants and antiseptics. In: Lennette EH, Spaulding EH, Traunt JP Manual of Clinical Microbiology. 2nd ed Washington, DC; American Society of Microbiology 1974: 852-857
  • 8 Ramsey A H, Oemig T V, Davis J P et al.. An outbreak of bronchoscopy-related Mycobacterium tuberculosis infections due to lack of bronchoscope leak testing.  Chest. 2002;  121 976-981
  • 9 Rutala W A, Weber D J. FDA labeling requirements for disinfection of endoscopes: a counterpoint.  Infect Control Hosp Epidemiol. 1995;  16 231-235
  • 10 Center for Devices and Radiologic Health-Food and Drug Administration .FDA-cleared sterilants and high level disinfectants with general claims for processing reusable medical and dental devices 1/30/02. At www.fda.gov/cdrh/ode/germlab.html
  • 11 Wiggins P, McCurdy S A, Zeindenburg W. Epistaxis due to glutraldehyde exposure.  J Occup Med. 1989;  31 854-856
  • 12 Nethercott J R, Holness D L, Page E. Occupational contact dermatitis due to glutaraldehyde in health care workers.  Contact Dermatitis. 1988;  18 193-196
  • 13 Corrado O J, Osman J, Davies R J. Asthma and rhinitis after exposure to glutaraldehyde in endoscopy units.  Hum Toxicol. 1986;  5 325-327
  • 14 Bradley C R, Babb J R. Endoscopic decontamination: automated vs manual.  J Hosp Infect. 1995;  30(suppl 1) 537-542
  • 15 Muscarella L F. Advantages and limitations of automatic flexible endoscope reprocessors.  Am J Infect Control. 1996;  24 304-309
  • 16 Reichert M. Automatic washers/disinfectors for flexible endoscopes.  Infect Control Hosp Epidemiol. 1991;  12 497-499
  • 17 Alfa M J. Importance of lumen flow in liquid chemical steilization.  Am J Infect Control. 1999;  27 373-374
  • 18 Rutala W J, Gergen M F, Weber D. Reply.  Am J Infect Control. 1999;  27 374-375
  • 19 Whitlock W L, Dietrich R A, Steimke E H et al.. Rhodotorula rubra contamination in fiberoptic bronchoscopy.  Chest. 1992;  102 1516-1519
  • 20 Vandenbroucke-Grauls C M, Baars A C, Visser M R et al.. An outbreak of Serratia marcescens traced to a contaminated bronchoscope.  J Hosp Infect. 1993;  23 263-270
  • 21 Cooke R P, Rhymant-Morris A, Umasankar R S et al.. Bacteria free water for automatic washers disinfectors: an impossible dream?.  J Hosp Infect. 1998;  39 63-65
  • 22 Alvarado C J, Reichelderfer M. APIC guideline for infection for infection prevention and control in flexible endoscopy.  Am J Infect Control. 2000;  28 138-155
  • 23 Wison S J, Everts R J, Kirkland K B et al.. A pseudo-outbreak of Aureobasidium species lower respiratory tract infections caused by reuse of single-use stopcocks during bronchoscopy.  Infect Control Hosp Epidemiol. 2000;  21 470-472
  • 24 Culver D A, Minai O A, Gordon S M, Mehta A C. Infection control and radiation safety in the bronchoscopy suite. In: Wang KP, Mehta AC, Turner JF Flexible Brochoscopy. 2nd ed Cambridge, MA; Blackwell Science 2003: 9-25
  • 25 Culver D A, Gordon S M, Mehta A C. Infection control in the bronchoscopy suite: a review of outbreaks and guidelines for prevention.  Am J Respir Crit Care Med. 2003;  167 1050-1056
  • 26 Centers for Disease Control and Prevention . Nosocomial infection and pseudoinfection from contaminated endoscopes and bronchoscopes: Wisconsin and Missouri.  MMWR Morb Mortal Wkly Rep. 1991;  40 675-678
  • 27 Kohn LT, Corrigan JM, Donaldson MS To err is human: building a safer health system. Washington DC; National Academy Press 2000
  • 28 Kacmarek R G, Moore R M, McCrohan J et al.. Multi-state investigation of the actual disinfection/sterilization of endoscopes on health care facilities.  Am J Med. 1992;  92 257-261
  • 29 Honeybourne D, Neumann C S. An audit of bronchoscopy practice in the United Kingdom: a survey of adherence to national guidelines.  Thorax. 1997;  52 709-713
  • 30 Gorse G J, Messner R L. Infection control practices in gastrointestinal endoscopy in the United States: a national survey.  Infect Control Hosp Epidemiol. 1991;  12 289-296
  • 31 Mehta A C, Minai O A. Infection control in the bronchoscopy suite.  Clin Chest Med. 1999;  20 19-32
  • 32 Hanson P VJ, Chadwick M V, Gaya H et al.. A study of glutaraldehyde disinfection of fiberoptic bronchoscpes experimentally contaminated with Mycobacterium tuberculsosis .  J Hosp Infect. 1992;  22 137-142
  • 33 Jackson J, Leggeh J E, Wilson D et al.. Mycobacterium gordonae in fiberoptic bronchoscopes.  Am J Infect Control. 1996;  24 19-23
  • 34 Seballos R L, Walsh A L, Mehta A C. Clinical evaluation of a liquid chemical sterilization for the flexible bronchoscope.  J Bronchol. 1995;  2 192-199
  • 35 Rutala W A. APIC guidelines for selection and use of disinfectants.  Am J Infect Control. 1996;  24 313-342
  • 36 Society of Gastroenterology Nurses and Associates Inc .Standards for infection control and reprocessing of flexible gastrointestinal endoscopes. Chicago; Society of Gastroenterology Nurses and Associates, Inc 1997
  • 37 American Society for Testing and Materials .Standard practice for cleaning and disinfection of flexible fiberoptic and video endoscopes used in the examination of hollow viscera. Designation F1518-94 Philadelphia, PA; ASTM 1994
  • 38 Woodcock A, Campbell I, Collins J VC et al.. Bronchoscopy and infection control.  Lancet. 1989;  2 270-271

Atul C MehtaM.B. B.S. 

Department of Pulmonary and Critical Care Medicine, The Cleveland Clinic Foundation, Desk A90

9500 Euclid Ave., Cleveland

OH 44195

Email: mehtaa1@ccf.org