Bronchoscopes still dirty after cleaning, study says

A new study has found that currently acceptable methods of reprocessing reusable bronchoscopes left most devices contaminated and damaged.

“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.

The study concludes that “shifting toward using sterilized or single-use bronchoscopes” could reduce the risk of life-threatening infection transmission among patients.