No CrossRef data available.
Article contents
Both microbiological surveillance and audit of procedures improve reprocessing of flexible bronchoscopes and patient safety
Published online by Cambridge University Press: 10 September 2021
Abstract
Background:
Microbiological surveillance of bronchoscopes and automatic endoscope reprocessors (AERs)/washer disinfectors as a quality control measure is controversial. Experts also are divided on the infection risks associated with bronchoscopic procedures.
Objective:
We evaluated the impact of routine microbiological surveillance and audits of cleaning/disinfection practices on contamination rates of reprocessed bronchoscopes.
Design:
Audits were conducted of reprocessing procedures and microbiological surveillance on all flexible bronchoscopes used from January 2007 to June 2020 at a teaching hospital in France. Contamination rates per year were calculated and analyzed using a Poisson regression model. The risk factors for microbiological contamination were analyzed using a multivariable logistical regression model.
Results:
In total, 478 microbiological tests were conducted on 91 different bronchoscopes and 57 on AERs. The rate of bronchoscope contamination significantly decreased between 2007 and 2020, varying from 30.2 to 0% (P < .0001). Multivariate analysis confirmed that retesting after a previous contaminated test was significantly associated with higher risk of bronchoscope contamination (OR, 2.58; P = .015). This finding was explained by the persistence of microorganisms in bronchoscopes despite repeated disinfections. However, the risk of persistent contamination was not associated with the age of the bronchoscope.
Conclusions:
Our results confirm that bronchoscopes can remain contaminated despite repeated reprocessing. Routine microbial testing of bronchoscopes for quality assurance and audit of decontamination and disinfection procedures can improve the reprocessing of bronchoscopes and minimize the rate of persistent contamination.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
References
Spaulding, EH. Chemical disinfection and antisepsis in the hospital. J Hosp Res 1972;9:5–31.Google Scholar
Circulaire DHOS/E 2/DGS/SD 5 C N° 2003-591 Du 17 Décembre 2003 Relative Aux Modalités de Traitement Manuel Pour La Désinfection Des Endoscopes Non Autoclavables Dans Les Lieux de Soins. Direction générale de la santé (DGS) website. https://solidarites-sante.gouv.fr/fichiers/bo/2004/04-01/a0010011.htm. Accessed August 31, 2021.Google Scholar
Professional standard handbook—flexible endoscopes—cleaning and disinfection. version 4.1. Dutch Advisory Board Cleaning and Disinfection Flexible Endoscopes (SFERD) website. https://www.infectiepreventieopleidingen.nl/downloads/SFERDHandbook4_1.pdf. Published 2017. Accessed August 31, 2021.Google Scholar
Infection prevention and control guideline for flexible gastrointestinal endoscopy and flexible bronchoscopy. Public Health Agency of Canada website. https://www.canada.ca/en/public-health/services/infectious-diseases/nosocomial-occupational-infections/infection-prevention-control-guideline-flexible-gastrointestinal-endoscopy-flexible-bronchoscopy.html. Published 2011. Accessed August 31, 2021.Google Scholar
Mehta, AC, Prakash, UBS, Garland, R, et al. American College of Chest Physicians and American Association for Bronchology Consensus Statement. Chest 2005;128:1742–1755.CrossRefGoogle Scholar
Healthcare Infection Control Practices Advisory Committee. Essential elements of a reprocessing program for flexible endoscopes—the recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC). Centers for Disease Control and Prevention website. https://www.cdc.gov/hicpac/pdf/flexible-endoscope-reprocessing.pdf. Published 2016. Accessed August 31, 2021.Google Scholar
Latta, S. ANSI/AAMI ST91:2015—Flexible and semi-rigid endoscope processing in healthcare facilities. Healthmark website. http://www.healthmark.info/InstrumentCare/OpticalInspection/ST91_White_Paper_2018-05-25.pdf. Accessed August 31, 2021.Google Scholar
Ofstead, CL, Quick, MR, Wetzler, HP, et al. Effectiveness of reprocessing for flexible bronchoscopes and endobronchial ultrasound bronchoscopes. Chest 2018;154:1024–1034.CrossRefGoogle ScholarPubMed
Marino, M, Grieco, G, Moscato, U, et al. Is reprocessing after disuse a safety procedure for bronchoscopy? A cross-sectional study in a teaching hospital in Rome. Gastroenterol Nurs 2012;35:324–330.CrossRefGoogle Scholar
Ofstead, CL, Dirlam Langlay, AM, Mueller, NJ, Tosh, PK, Wetzler, HP. Re-evaluating endoscopy-associated infection risk estimates and their implications. Am J Infect Control 2013;41:734–736.CrossRefGoogle ScholarPubMed
Saliou, P, Garlantézec, R, Baron, R, et al. Contrôles microbiologiques des endoscopes au centre hospitalier régional de Brest du 1er janvier 2007 au 31 décembre 2009. Pathologie Biologie 2011;59:88–93.CrossRefGoogle Scholar
Waite, TD, Georgiou, A, Abrishami, M, Beck, CR. Pseudo-outbreaks of Stenotrophomonas maltophilia on an intensive care unit in England. J Hosp Infect 2016;92:392–396.CrossRefGoogle Scholar
Kovaleva, J, Peters, FTM, van der Mei, HC, Degener, JE. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev 2013;26:231–254.Google ScholarPubMed
Zhang, Y, Zhou, H, Jiang, Q, Wang, Q, Li, S, Huang, Y. Bronchoscope-related Pseudomonas aeruginosa pseudo-outbreak attributed to contaminated rinse water. Am J Infect Control 2020;48:26–32.CrossRefGoogle ScholarPubMed
DiazGranados, CA, Jones, MY, Kongphet-Tran, T, et al. Outbreak of Pseudomonas aeruginosa infection associated with contamination of a flexible bronchoscope. Infect Control Hosp Epidemiol 2009;30:550–555.Google ScholarPubMed
Silva, CV, Magalhães, VD, Pereira, CR, Kawagoe, JY, Ikura, C, Ganc, AJ. Pseudo-outbreak of Pseudomonas aeruginosa and Serratia marcescens related to bronchoscopes. Infect Control Hosp Epidemiol 2003;24:195–197.CrossRefGoogle ScholarPubMed
Botana-Rial, M, Leiro-Fernández, V, Núñez-Delgado, M, et al. A pseudo-outbreak of Pseudomonas putida and Stenotrophomonas maltophilia in a bronchoscopy unit. Respiration 2016;92:274–278.Google Scholar
Galdys, AL, Marsh, JW, Delgado, E, et al. Bronchoscope-associated clusters of multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2019;40:40–46.CrossRefGoogle ScholarPubMed
Ofstead, CL, Doyle, EM, Eiland, JE, et al. Practical tool kit for monitoring endoscope reprocessing effectiveness: identification of viable bacteria on gastroscopes, colonoscopes, and bronchoscopes. Am J Infect Control 2016;44:815–819.Google Scholar
Gavaldà, L, Olmo, AR, Hernández, R, et al. Microbiological monitoring of flexible bronchoscopes after high-level disinfection and flushing channels with alcohol: results and costs. Respir Med 2015;109:1079–1085.CrossRefGoogle ScholarPubMed
Sorin, M, Segal-Maurer, S, Mariano, N, Urban, C, Combest, A, Rahal, JJ. Nosocomial transmission of imipenem-resistant Pseudomonas aeruginosa following bronchoscopy associated with improper connection to the Steris System 1 processor. Infect Control Hosp Epidemiol 2001;22:409–413.Google Scholar
Yassin, MH, Hariri, R, Hamad, Y, Ferrelli, J, McKibben, L, Doi, Y. Disposable bronchoscope model for simulating endoscopic reprocessing and surveillance cultures. Infect Control Hosp Epidemiol 2017;38:136–142.CrossRefGoogle ScholarPubMed
Xia, Y, Lu, C, Zhao, J, et al. A bronchofiberoscopy-associated outbreak of multidrug-resistant Acinetobacter baumannii in an intensive care unit in Beijing, China. BMC Infect Dis 2012;12:335.CrossRefGoogle Scholar
Beilenhoff, U, Neumann, CS, Rey, JF, et al. ESGE-ESGENA guideline for quality assurance in reprocessing: microbiological surveillance testing in endoscopy. Endoscopy 2007;39:175–181.CrossRefGoogle ScholarPubMed
Commission for Hospital Hygiene and Infection Prevention (KRINKO), Federal Institute for Drugs and Medical Devices. Hygiene requirements for the reprocessing of medical devices. Recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute (RKI) and the Federal Institute for Drugs and Medical Devices (BfArM). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012;55:1244–1310.Google Scholar
Du Rand, IA, Blaikley, J, Booton, R, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax 2013;68 suppl 1:i1–i44.Google Scholar
Eléments d’assurance Qualité En Hygiène Relatifs Au Contrôle Microbiologique Des Endoscopes et à La Traçabilité En Endoscopie. Direction générale de la santé (DGS) website. https://solidarites-sante.gouv.fr/IMG/pdf/microbio_endoscopes-2.pdf. Published 2007. Accessed August 31, 2021.Google Scholar
Gabard, A, Borderan, G-C, Chevrie, N, et al. Microbiological monitoring of endoscopes: factors determining nonconformities. Hygienes 2013;21:141–144.Google Scholar
Saliou, P, Cholet, F, Jézéquel, J, Robaszkiewicz, M, Le Bars, H, Baron, R. The use of channel-purge storage for gastrointestinal endoscopes reduces microbial contamination. Infect Control Hosp Epidemiol 2015;36:1100–1102.Google ScholarPubMed
Brown, SA, Merritt, K, Woods, TO, McNamee, SG, Hitchins, VM. Effects of different disinfection and sterilization methods on tensile strength of materials used for single-use devices. Biomed Instrum Technol 2002;36:23–27.CrossRefGoogle ScholarPubMed
Saliou, P, Le Bars, H, Payan, C, et al. Measures to improve microbial quality surveillance of gastrointestinal endoscopes. Endoscopy 2016;48:704–710.Google ScholarPubMed
Verfaillie, C, Bruno, M, Voor in’t holt A, F., et al. Withdrawal of a novel-design duodenoscope ends outbreak of a VIM-2-producing Pseudomonas aeruginosa.
Endoscopy 2015;47:493–502.Google ScholarPubMed
Muscarella, LF. Inconsistencies in endoscope-reprocessing and infection-control guidelines: the importance of endoscope drying. Am J Gastroenterol 2006;101:2147–2154.CrossRefGoogle ScholarPubMed
Otter, JA, Vickery, K, Walker, JT, et al. Surface-attached cells, biofilms and biocide susceptibility: implications for hospital cleaning and disinfection. J Hosp Infect 2015;89:16–27.CrossRefGoogle ScholarPubMed