Table 5.
Infections associated with flexible bronchoscopy
| Reference | Microorganism(s) | No. of contaminated patients after endoscopy | No. of infected patients | Infection(s) | Detection of endoscope contamination | Cause(s) of contaminationa |
|---|---|---|---|---|---|---|
| 73 | P. aeruginosa | 11 | 1 | Pneumonia | Yes | Inappropriate cleaning and disinfection (povidone-iodine); drying with no ethanol flushing |
| 70 | P. aeruginosa | 8 | 0 | No | Yes | Lack of manual cleaning; drying with no ethanol flushing |
| 102 | P. aeruginosa | 35 | No data | No data | Yes | Contaminated AER |
| 104 | P. aeruginosa | 18 | 3 | Pneumonia | No data | Inadequate cleaning and disinfection (incorrect connectors) |
| 26 | P. aeruginosa | 8 | 8 | Sepsis, pneumonia | Yes | Contaminated AER (biofilm on internal plumbing); no protocol for manual cleaning; lack of drying procedure |
| 103 | P. aeruginosa | 18 | 3 | Pneumonia | Yes | Contaminated AER; incorrect AER connectors (obstruction of disinfectant flow) |
| 107 | P. aeruginosa, S. marcescens | 20 (P. aeruginosa), 6 (S. marcescens) | 1 | Pneumonia | Yes | Loose biopsy port cap of the contaminated bronchoscopes |
| 30 | P. aeruginosa, S. marcescens | 41 | 0 | No | Yes | Insufficient disinfectant exposure; rinsing with tap water; drying with no ethanol flushing |
| 93 | P. aeruginosa | 32 | 32 | Pneumonia, bacteremia/sepsis, bronchitis, sinusitis | Yes | Loose biopsy port cap of the contaminated bronchoscopes |
| 105 | P. aeruginosa | 16 | 4 | Pneumonia | Yes | Defective biopsy forceps and damaged endoscope channel |
| 64 | P. aeruginosa | 10 | 7 | Pneumonia, bronchitis | Not tested | Inappropriate disinfection (povidone-iodine); lack of drying procedure |
| 74 | P. aeruginosa | 7 | 7 | Pneumonia, bronchitis | Yes | Contaminated AER (detergent tank); inadequate manual cleaning; drying with no ethanol flushing |
| 106 | P. aeruginosa | 12 | 12 | Pneumonia, sepsis | Yes | Multiple manufacturing defects of the contaminated bronchoscope |
| 27 | M. tuberculosis | 1 | 0 | No | No data | Inappropriate disinfection (iodophor solution); lack of manual cleaning; drying procedure not described |
| 109 | M. tuberculosis | 2 | 1 | Lung tuberculosis | Yes | Inappropriate disinfection (iodophor solution) |
| 111 | M. tuberculosis | 3 | 1 | Lung tuberculosis | Yes | Contaminated suction valves (failure to disinfect with glutaraldehyde) |
| 63 | M. tuberculosis | 3 | 1 | Multidrug-resistant lung tuberculosis | Yes | Inadequate cleaning and disinfection (no immersion in disinfectant); drying with no ethanol flushing |
| 66 | M. tuberculosis | 1 | 0 | No | No data | Inappropriate cleaning and disinfection; lack of drying procedure |
| 108 | M. tuberculosis | 1 | 1 | Lung tuberculosis | No data | Inappropriate cleaning and disinfection; drying procedure not described |
| 125 | M. tuberculosis | 8 | 0 | No | Yes | Contaminated automated aspiration adaptor (no manual cleaning and disinfection) |
| 104 | M. tuberculosis | 4 | 0 | No | No | Inadequate cleaning and disinfection (biopsy port cap was not replaced before loading into the AER) |
| 110 | M. tuberculosis | 9 | 3 | Lung tuberculosis | No | Hole in the sheath of the bronchoscope (no leak testing performed) |
| 120 | M. tuberculosis | 2 | 0 | No | No | Inadequate cleaning and disinfection between uses in patients (incompatibility of the bronchoscope and AER) |
| 67 | M. chelonae | 7 | 0 | No | No | Contaminated AER; drying with no ethanol flushing |
| 124 | M. chelonae | 72 | 2 | No data | Yes | Contaminated suction channel (punctured channel) |
| 71 | M. chelonae | 7 | 0 | No | Yes | Rinsing with contaminated tap water; drying with no ethanol flushing |
| 126 | M. chelonae | 4 | 0 | No | Yes | Contaminated suction channel valve; inadequate endoscope reprocessing |
| 52 | M. chelonae | 14 | 0 | No | No data | Contaminated AER; inappropriate disinfection; rinsing with tap water; lack of drying procedure |
| 24 | M. chelonae | 14 | 0 | No | No data | Contaminated AER; inappropriate cleaning and disinfection; drying with no ethanol flushing |
| 68 | M. chelonae, M. gordonae | 14 | 0 | No | No data | Contaminated AER (rinse water tank); drying with no ethanol flushing |
| 122 | M. chelonae | 12 | 0 | No | Yes | Contaminated AER; inadequate endoscope reprocessing |
| 123 | M. chelonae | 13 | 0 | No | No data | Contaminated AER; inadequate endoscope reprocessing |
| 76 | M. chelonae | 15 | 0 | No | Yes | Contaminated AER; inappropriate disinfection; drying with no ethanol flushing |
| 127 | M. chelonae | 18 | 0 | No | Yes | Contaminated suction channels; inappropriate disinfection and drying |
| 25 | M. chelonae, Methylobacterium mesophilicum | 20 | 0 | No | Yes | Contaminated AER (presence of biofilm) |
| 111 | M. avium complex | 2 | 0 | No | Yes | Contaminated suction valve (failure to disinfect with glutaraldehyde) |
| 104 | M. avium complex | 7 | 0 | No | No | Inadequate cleaning and disinfection (incorrect connectors) |
| 56 | M. xenopi | 2 | 0 | No | No data | Rinsing with contaminated tap water |
| 51 | M. xenopi | 20 | 3 | Pulmonary infection, abscess | Yes | Rinsing with contaminated tap water; inadequate disinfection and drying between uses in patients |
| 121 | Mycobacterium spp. (patients), M. chelonae and M. fortuitum (AER) | 15 | 0 | No | No data | Contaminated AER; endoscope reprocessing not described |
| 142 | S. marcescens | 3 | 3 | Pneumonia | Yes | Inappropriate cleaning and disinfection (ethanol) |
| 55 | S. marcescens | 4 | 0 | No | Yes | Inappropriate disinfection (ethanol); rinsing with tap water |
| 57 | S. marcescens | 6 | 5 | Bacteremia/sepsis, pneumonia, wound infection | Yes | Inappropriate cleaning and disinfection; rinsing with tap water; lack of drying procedure |
| 72 | S. marcescens | 53 (no data about endoscopy) | Yes | Bacteremia/sepsis, pneumonia, wound infection | Yes | Drying with no ethanol flushing |
| 153 | R. rubra | 30 | 0 | No | No | Contaminated cleaning brushes |
| 69 | R. rubra | 11 | 0 | No | Yes | Contaminated suction channel; drying with no ethanol flushing; disinfection procedure not described |
| 156 | Bacillus sp. | 10 | 0 | No | Yes | Contaminated suction valves (no disassembling prior to cleaning); inappropriate cleaning and disinfection (ethanol) |
| 54 | M. mesophilicum | 7 | 0 | No | No | Rinsing with contaminated tap water; endoscope reprocessing not described |
| 154 | Blastomyces dermatitidis | 2 | 0 | No | Not tested | Inadequate manual cleaning; drying procedure not described |
| 155 | Legionella pneumophila | 3 | 0 | No | Not tested | Rinsing with contaminated tap water (inadequate maintenance of the filters) |
| 143 | Klebsiella pneumoniae, Proteus mirabilis, Morganella morganii, Proteus vulgaris | 117 | 0 | No | Yes | Loose biopsy port cap of the contaminated bronchoscope |
a
AER, automated endoscope reprocessor.