Lessons From Outbreaks Associated With Bronchoscopy

Bronchoscopy is currently the most commonly employed invasive procedure in the practice of pulmonary medicine.1 An estimated 497,000 bronchoscopy procedures were performed in the United States in 1996. 2 Current and new applications include bronchoscopic ultrasound, laser therapy, brachytherapy, electrocautery, cryotherapy, placement of airway stents, and balloon dilatation to relieve airway obstruction caused by airway lesions.3 Flexible endoscopes also are widely used in other medical disciplines.For example, more than 10,000,000 gastrointestinal endoscopies are performed each year.4 Endoscopes represent the medical devices most commonly linked to nosocomial outbreaks and pseudooutbreaks.5 Flexible endoscopes present a challenge for low-temperature sterilization or high-level disinfection, because they have long narrow lumens, cross-connections, mated surfaces, sharp angles, springs and valves, occluded dead ends, absorbent material, and rough or pitted surfaces.6,7 Failure to eradicate contamination that occurred during use may lead to person-to-person transmission of pathogens (eg, Mycobacterium tuberculosis); failure to prevent contamination during disinfection or storage may lead to outbreaks or pseudo-outbreaks from environmental microbes (eg, nontuberculous mycobacteria, or Rhodotorula rubra).In this issue, Sorin and colleagues 8 describe the nosocomial transmission of an imipenemresistant strain of Pseudomonas aeruginosa, and Kressel and Kidd 9 describe a pseudo-outbreak involving organisms relatively resistant to glutaraldehyde (ie, Mycobacterium chelonae and Methylobacterium mesophilicum) associated with the use of contaminated bronchoscopes.