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[Prevention of infection transmitted by bronchial fibroscopes]
C Belleguic1, H Léna, B Desrues
1Service de Pneumologie, Hôpital Pontchaillou, CHU, rue Henri le Guillou, 35000 Rennes, France. chantal.belleguic@chu-rennes.fr
Abstract:
A growing number of infectious complications are reported after bronchial fibroscopy procedures. The risk of nosocomial patient-to-patient or environment-to-patient infection is real via contaminated fibroscopes. Cross transmission can be caused by several microorganisms, the most frequently identified being Pseudomonas aeruginosa, Mycobacterium tuberculosis and other atypical mycobacteria. Fibroscopes can be contaminated via different mechanisms, generally related to poorly adapted cleaning and decontamination protocols. Identified errors include an insufficient cleaning phase, an inappropriate disinfecting agent (iodine derivatives, chlorhexidine), defective cleaning or disinfection of accessory equipment, or use of tap water for rinsing. Finally several episodes of Pseudomonas and atypical mycobacteria infections have been found to result from the use of automatic cleaning machines. Particular attention must be paid to the use of these devices. Official guidelines for the disinfection of endoscopic equipment must be rigorously applied in all centers. The personnel should have adequate training. It is also important to take regular samples and make regular bacteriology controls of the water and fibroscopic equipment.
Insights
Bronchial fibroscopy can lead to infectious complications due to contaminated equipment. Strict adherence to cleaning protocols and regular testing are crucial to prevent the spread of infections like Pseudomonas aeruginosa.
Area of Science:
- Infectious Diseases
- Medical Device Decontamination
- Pulmonology
Context:
- Bronchial fibroscopy is associated with a rising incidence of infectious complications.
- Contaminated bronchoscopes pose a significant risk for nosocomial infections, including patient-to-patient and environment-to-patient transmission.
- Commonly implicated microorganisms include Pseudomonas aeruginosa, Mycobacterium tuberculosis, and atypical mycobacteria.
Purpose:
- To highlight the risks of infectious complications following bronchial fibroscopy.
- To identify common sources and mechanisms of bronchoscope contamination.
- To emphasize the importance of proper cleaning, disinfection, and quality control.
Summary:
- Inadequate cleaning and decontamination protocols are primary causes of bronchoscope contamination.
- Errors include insufficient cleaning, use of inappropriate disinfectants (e.g., iodine derivatives, chlorhexidine), improper cleaning of accessories, and rinsing with tap water.
- Automatic cleaning machines have been linked to outbreaks of Pseudomonas and atypical mycobacteria infections, necessitating careful use and adherence to guidelines.
Impact:
- Rigorous application of official guidelines for endoscopic equipment disinfection is essential in all healthcare settings.
- Adequate training for personnel involved in reprocessing bronchoscopes is critical.
- Regular sampling and bacteriological monitoring of water and equipment are vital for preventing infection transmission.