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Disclosures: Ofstead reports having received research grants, study materials, educational materials or consulting contracts from 3M, Ambu/Invendo, Auris Health, Advanced Sterilization Products, Boston Scientific, Laborie/Cogentix, Convergascent, Endoscopy Repair Specialists, Fortive, Healthmark, Cantel/Medivators, Mobile Instrument, Nanosonics and Steris. Please see the study for all other authors’ relevant financial disclosures.
May 05, 2020
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Inadequately reprocessed bronchoscopes may contribute to transmission of COVID-19, other infections

Disclosures: Ofstead reports having received research grants, study materials, educational materials or consulting contracts from 3M, Ambu/Invendo, Auris Health, Advanced Sterilization Products, Boston Scientific, Laborie/Cogentix, Convergascent, Endoscopy Repair Specialists, Fortive, Healthmark, Cantel/Medivators, Mobile Instrument, Nanosonics and Steris. Please see the study for all other authors’ relevant financial disclosures.
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Nearly 30% of bronchoscopes at five U.S. hospitals were positive for “high-concern organisms or actionable levels of microbial growth,” including mold and gram-negative bacteria, because of inadequate reprocessing, which may lead to bronchoscopy-associated transmission of COVID-19 or other pathogens that could cause secondary infections, according to a letter to the editor in Infection Control & Hospital Epidemiology.

The idea for the study came from papers in China that examined the results of samples taken from bronchoscopes, according to Cori L. Ofstead, MSPH, president and CEO of Ofstead and Associates, an independent research organization.

“The lab results caught my eye because samples from patients’ lungs contained the COVID-19 virus, as well as fungi, waterborne pathogens and bacteria generally found in the gastrointestinal system. Those germs should not be there,” Ofstead told Healio. “The studies found patients with secondary infections had worse outcomes. Our previous studies had found similar bacteria and fungi in bronchoscopes that had been improperly cleaned and disinfected. We began to wonder whether dirty scopes could contribute to erroneous lab results or even to infection transmission.”

Numerous nosocomial outbreaks and pseudo-outbreaks have been associated with “inadequately reprocessed” bronchoscopes, according to the study. Ofstead and colleagues performed several prospective studies that assessed the effectiveness of bronchoscope reprocessing in five hospitals in the United States.

The studies showed that the process used to decontaminate reusable bronchoscopes failed to eliminate microbes the majority of the time, Ofstead told Healio. The researchers detected microbial growth on 65.7% of the bronchoscopes. Additionally, more than a quarter of the bronchoscopes (28.6%) harbored germs or bacteria “of high concern,” including mold and gram-negative bacteria such as Stenotrophomona maltophilia, Sphingomonas Phyllosphaerae and Escherichia coli/Shigella. Visual inspections that used magnification and borescopes found residue or defects on 100% of the bronchoscopes examined, according to the paper.

There is “an urgent need” to limit the number of patients who require hospitalization or intensive care in the midst of the COVID-19 pandemic, the authors wrote, “in part because of shortages of ventilators and personal protective equipment.” They note that the possibility of bronchoscopy-associated transmission of COVID-19 or other pathogens must be considered in light of the findings.

“To ensure patient safety and reduce the risk of exposing health care personnel to COVID-19 and other germs, hospitals should use sterile, single-use bronchoscopes or take steps to ensure their methods for cleaning and sterilizing bronchoscopes are optimized,” Ofstead said. “This is not a time to be cutting corners. We hope that institutions will make sure that their sterile processing departments receive the supplies and staffing they need to ensure safety for personnel, patients, and the community.” – by Caitlyn Stulpin

Disclosures: Ofstead reports having received research grants, study materials, educational materials or consulting contracts from 3M, Ambu/Invendo, Auris Health, Advanced Sterilization Products, Boston Scientic, Laborie/Cogentix, Convergascent, Endoscopy Repair Specialists, Fortive, Healthmark, Cantel/Medivators, Mobile Instrument, Nanosonics and Steris. Please see the study for all other authors’ relevant financial disclosures.