Infection Control in the Bronchoscopy Suite: A Review of Outbreaks and Guidelines for Prevention

choscope, a contaminating organism is isolated from bronchoMost bronchoscopists are familiar with a 1 to 3% rate of scopic specimens in a patient with no clinical evidence of disease immediate, procedure-related complications due to bronchos- attributable to that organism. A pseudoepidemic or pseudo-outcopy (5). In contrast, reports of bronchoscopic pathogen trans- break occurs when the organism is isolated in bronchoscopic mission have been scattered and largely anecdotal. Under-recog- specimens from multiple patients. True infection implies develnition and under-reporting of such episodes have contributed opment of actual clinical disease in a patient after undergoing to a sense of complacency regarding infection control in the bronchoscopy with the contaminated instrument. bronchoscopy suite. With recent events, renewed attention may Review of the available cases reveals that the data are limited be focused on infection control. However, the burgeoning sensa- in several aspects. Most of the reports are descriptive series, tion of time-pressure and administrative demands for economic with few case‐control investigations. In many of the episodes, thrift will likely intensify the temptation to “cut corners.” the causality between the clinical scenario, putative offending Bronchoscopic infectious complications include distal spread organism, and ostensible mechanism of contamination is tenuof organisms within a patient during bronchoscopy, transmission ous. Most importantly, because there are no prospective studies of organisms to subsequent patients via contaminated instru- of pathogen transmission, the actual incidence is unknown. In ments, accessories or solutions, and transmission of infectious light of the unclear significance of the problem, the urgency to agents to medical personnel or nearby patients. Distal spread intensify infection control recommendations is unclear. of infection is rarely clinically significant, although the exact The most recent reports (2, 3) are the first to describe pathoincidence is unknown (6); it may include contamination of the gen transmission despite adherence to all current (2003) relower respiratory tract with organisms from the upper respira- processing standards. Epidemiologic investigations in both intory tract, extension of infection within the lung, and hematoge- stances implicated loose fittings over the valve stem for the nous dissemination to distant organs (6). Distal pathogen spread working channel of certain bronchoscope models. In this sceis a complication of the procedure itself and will not be discussed nario, effective mechanical cleaning and disinfection would be further here. This article reviews the available evidence regard- impossible. In total, there were multiple pseudoinfections and ing transmitted infectious hazards of bronchoscopy. We will also 20 to 43 possible true infections, including up to three deaths, provide guidelines for the prevention of infections associated due mainly to Pseudomonas aeruginosa. As both series were with bronchoscopes.