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An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes

Arjun Srinivasan1, Linda L Wolfenden, Xiaoyan Song

  • 1Department of Hospital Epidemiology and Infection Control, Johns Hopkins Medical Institutions, Baltimore, Md, USA.

The New England Journal of Medicine
|January 17, 2003
PubMed
Abstract

Insights

A Pseudomonas aeruginosa outbreak linked to bronchoscopes caused increased infections and deaths. Contaminated bronchoscopes, possibly due to a faulty cap, led to 9.4% of patients developing infections. Improved device safety and recalls are crucial.

Area of Science:

  • Infectious Diseases
  • Medical Device Safety
  • Epidemiology

Background:

  • Endoscopes, particularly bronchoscopes, are frequently implicated in nosocomial infection outbreaks.
  • This study investigated a specific outbreak of Pseudomonas aeruginosa infections following bronchoscopic procedures.

Purpose of the Study:

  • To investigate an outbreak of Pseudomonas aeruginosa infections associated with bronchoscopy.
  • To identify the source and contributing factors of the outbreak.

Main Methods:

  • Reviewed microbiologic data to assess P. aeruginosa recovery rates from bronchoalveolar-lavage specimens.
  • Cultured environmental samples from endoscopes and the endoscopy suite.
  • Examined medical records to identify patient infections post-bronchoscopy.

Main Results:

  • P. aeruginosa recovery rates significantly increased during the outbreak (31.0% vs. 10.4% baseline).
  • Three bronchoscopes tested positive for P. aeruginosa; these were part of a nationwide recall.
  • 9.4% of patients (39/414) developed infections, with P. aeruginosa confirmed in 66.7% of cases. Three deaths were potentially linked to contaminated bronchoscopes.

Conclusions:

  • A loose biopsy-port cap on bronchoscopes was the likely cause of this large P. aeruginosa outbreak.
  • Enhanced instrument safety, surveillance, and medical device recall procedures are necessary for bronchoscopy.
  • Removing contaminated instruments returned P. aeruginosa recovery rates to baseline.

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