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Updated: Aug 2, 2025
Author Spotlight: Learning Systematic Bronchoscopy in a Simulation-Base Setting
Published on: June 23, 2023
Cross-contamination rate of reusable flexible bronchoscopes: A systematic literature review and meta-analysis
Helena S Travis1, Rasmus V Russell1, Julia Kovaleva2
1Ambu A/S, Ballerup, Denmark.
Background:
Bronchoscopy is generally a safe and efficient procedure. However, the risk of cross-contamination with reusable flexible bronchoscopes (RFB) has been detected in several outbreaks worldwide.
Aim:
To estimate the average cross-contamination rate of patient-ready RFBs based on available published data.
Methods:
We performed a systematic literature review in PubMed and Embase to investigate the cross-contamination rate of RFB. Included studies identified indicator organisms or colony forming units (CFU) levels, and total number of samples >10. The Contamination threshold was defined according to the European Society of Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy Nurse and Associates (ESGE-ESGENA) guidelines. To calculate the total contamination rate, a random effects model was applied. Heterogeneity was analysed via a Q-test and illustrated in a forest plot. Publication bias was analysed via the Egger's regression test and illustrated in a funnel plot.
Results:
Eight studies fulfilled our inclusion criteria. The random effects model included 2169 samples and 149 events (positive tests). The total RFB cross-contamination rate was 8.69% ± 1.86 (standard division [SD]) (95% confidence interval [CI]: 5.06-12.33%). The result showed significant heterogeneity of 90% and publication bias.
Discussion:
Significant heterogeneity and publication bias is likely associated with varying methodology and aversion towards publishing negative findings, respectively. Based on the cross-contamination rate an infection control paradigm shift is needed to ensure patient safety. We recommend to follow the Spaulding classification and classify RFBs as critical items. Accordingly, infection control measures such as obligatory surveillance, and implementing single-use alternatives must be considered where feasible.
Insights
Reusable flexible bronchoscopes (RFB) pose a cross-contamination risk, with an average rate of 8.69%. This highlights the need for enhanced infection control measures and consideration of single-use alternatives to ensure patient safety.
Area of Science:
- Infection Control
- Medical Device Safety
- Public Health
Background:
- Bronchoscopy is a common medical procedure.
- Reusable flexible bronchoscopes (RFB) carry a risk of cross-contamination.
- Previous outbreaks have been linked to RFB.
Purpose of the Study:
- To determine the average cross-contamination rate of patient-ready RFBs.
- To synthesize data from published literature on RFB contamination.
Main Methods:
- Systematic literature review of PubMed and Embase.
- Included studies quantified indicator organisms or colony forming units (CFU).
- A random effects model was used to calculate the overall contamination rate.
Main Results:
- Eight studies met inclusion criteria, analyzing 2169 samples.
- The average RFB cross-contamination rate was 8.69% (±1.86 SD, 95% CI: 5.06-12.33%).
- Significant heterogeneity (90%) and publication bias were observed.
Conclusions:
- High heterogeneity suggests variations in methodology.
- Publication bias may stem from reluctance to report negative findings.
- An infection control paradigm shift is necessary, classifying RFBs as critical items and considering single-use alternatives.
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