Caveat Emptor: The Role of Suboptimal Bronchoscope Repair Practices by a Third-Party Vendor in a Pseudo-Outbreak ofPseudomonasin Bronchoalveolar Lavage Specimens

Cosgrove, Sara E.; Ristaino, Polly; Caston-Gaa, Anne; Fellerman, Donna; Nowakowski, Elaine; Carroll, Karen C.; Orens, Jonathan B.; Perl, Trish M.; Maragakis, Lisa L.

doi:10.1086/664051

Cited by 14 publications

(17 citation statements)

References 14 publications

(6 reference statements)

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“…Bronchoscope contamination by P. aeruginosa/S. maltophilia was reported in the investigation of a pseudo-outbreak in Baltimore, US in 2008 [27] and more recently, contamination by S. maltophilia was reported in the Netherlands [28].…”

Section: Discussionmentioning

confidence: 99%

Outbreak of pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia infections related to contaminated bronchoscope suction valves, Lyon, France, 2014

et al. 2016

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In April 2014, pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia co-infections potentially related to bronchoscopic procedures were identified in the intensive care units of a university hospital in Lyon, France. A retrospective cohort of 157 patients exposed to bronchoscopes from 1 December 2013 to 17 June 2014 was analysed. Environmental samples of suspected endoscopes were cultured. Bronchoscope disinfection was reviewed. Ten cases of pulmonary P. aeruginosa/S. maltophilia co-infections were identified, including two patients with secondary pneumonia. Eight cases were linked to bronchoscope A1 and two to bronchoscope A2. Cultures deriving from suction valves were positive for P. aeruginosa/S. maltophilia. Exposure to bronchoscopes A1 and A2 was independently coupled with increased risk of co-infection (adjusted odds ratio (aOR) = 84.6; 95% confidence interval (CI): 9.3-771.6 and aOR = 11.8, 95% CI: 1.2-121.3). Isolates from suction valves and clinical samples presented identical pulsotypes. The audit detected deficiencies in endoscope disinfection. No further cases occurred after discontinuation of the implicated bronchoscopes and change in cleaning procedures. This outbreak of pulmonary P. aeruginosa/S. maltophilia co-infections was caused by suction valve contamination of two bronchoscopes of the same manufacturer. Our findings underscore the need to test suction valves, in addition to bronchoscope channels, for routine detection of bacteria.

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Section: Discussionmentioning

confidence: 99%

Outbreak of pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia infections related to contaminated bronchoscope suction valves, Lyon, France, 2014

et al. 2016

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“…Pseudo-outbreaks caused by bacterial, fungal, and viral pathogens are well documented and have been traced to a variety of sources, including contaminated medical or laboratory equipment, tap water rinsing, use of nonsterile solutions in the microbiology laboratory, and specimen cross-contamination (4,(7)(8)(9)(10)(11)(12)(13). They have also been traced to highly contaminated environments, such as drinking water and ice machines (14,15), which may introduce microorganisms into patients or clinical specimens during collection.…”

Section: Discussionmentioning

confidence: 99%

Investigation of a Candida guilliermondii Pseudo-outbreak Reveals a Novel Source of Laboratory Contamination

et al. 2017

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was isolated from sterile specimens with increasing frequency over a several-month period despite a paucity of clinical evidence suggesting true infections. However, a health care-associated outbreak was strongly considered due to growth patterns in the microbiology laboratory that were more consistent with true infection than environmental contamination. Therefore, an extensive investigation was performed to identify its cause. With the exception of one case, patient clinical courses were not consistent with true invasive fungal infections. Furthermore, no epidemiologic link between patients was identified. Rather, extensive environmental sampling revealed in an anaerobic holding jar in the clinical microbiology laboratory, where anaerobic plates were prereduced and held before inoculating specimens. grows poorly under anaerobic conditions. Thus, we postulate that anaerobic plates became intermittently contaminated. Passaging from intermittently contaminated anaerobic plates to primary quadrants of aerobic media during specimen planting yielded a colonial growth pattern typical for true specimen infection, thus obscuring laboratory contamination. A molecular evaluation of the isolates confirmed a common source for pseudo-outbreak cases but not for the one true infection. In line with Reason's model of organizational accidents, active and latent errors coincided to contribute to the pseudo-outbreak. These included organism factors (lack of growth in anaerobic conditions obscuring plate contamination), human factors (lack of strict adherence to plating order, leading to only intermittent observation of aerobic plate positivity), and laboratory factors (novel equipment). All of these variables should be considered when evaluating possible laboratory-based pseudo-outbreaks.

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“…Although infectious complications of flexible bronchoscopy are uncommon, outbreaks and pseudo-outbreaks related to bronchoscopy have been reported [3][4][5][8][9][10][11][12][13] . The proper method for high-level disinfection or sterilization of bronchoscopes is well described in current guidelines [1,2,7] .…”

Section: Discussionmentioning

confidence: 99%

“…Although the risk of endoscopy-related transmission of infection is estimated to be very low, more health care-associated infections are related to contaminated endoscopes than to any other medical device. However, most of the recent outbreaks and pseudo-outbreaks have resulted from contaminated automated endoscope reprocessors (AER) or the use of damaged or malfunctioning bronchoscopes or contaminated equipment, including rinsing tanks, tubing, antibacterial filters on water lines, and cleaning brushes [3][4][5] . Most reports refer to pseudo-outbreaks as the isolation of organisms in bronchoscopy specimens due to colonization or contamination of the bronchoscope rather than true patient-to-patient transmission ('true infection') [5,6] .…”

Section: Introductionmentioning

confidence: 99%

A Pseudo-Outbreak of Pseudomonas putida and Stenotrophomonas maltophilia in a Bronchoscopy Unit

et al. 2016

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39 patients. The bronchoscopy models Olympus BF-1T160 and BF-160 were contaminated. Both bronchoscopes and other contaminated material (cleaning brushes, diluted cleaning solutions, and the sink) were isolated, but new cases continued to appear. The AER was recently installed, and new connections were used for the water lines and new tubes were connected to the AER. Initially, specimens were obtained from the external circuits and the internal walls of the AER. Finally, cultures were made from the filters on the water lines, and growth of P. putida and S. maltophilia was found. The investigation revealed that the BW specimens were contaminated because sterile saline was injected by means of the biopsy port of the bronchoscope and was recovered through the same channel by means of the proximal suction port. No patients developed clinical signs or symptoms of infection, but the positive cultures did lead to treatment of 21 patients. Conclusions: We described a pseudooutbreak related to a contaminated bronchoscope because of inadequate installation of the AER for used new water lines and because the new tubes were connected to the AER. The antibacterial filters of the AER used tap water, and this may have contained low levels of microorganisms. No serious clinical complications derived from this pseudo-outbreak. © 2016 S. Karger AG, Basel Key WordsBronchoscope · Pseudo-outbreak · Automated endoscope reprocessor · Pseudomonas putida · Stenotrophomonas maltophilia Abstract Background: Endoscopes represent the medical devices most commonly linked to health care-associated outbreaks and pseudo-outbreaks. Most of the recent outbreaks and pseudo-outbreaks have resulted from contaminated automated endoscope reprocessors (AER) or the use of damaged or malfunctioning bronchoscopes or contaminated equipment. Objectives: We investigated a pseudo-outbreak of Pseudomonas putida and Stenotrophomonas maltophilia recovered from bronchial washing (BW) specimens obtained during bronchoscopy in a bronchoscopy unit. Methods: Samples were obtained from environmental surfaces in the endoscopy suite, bronchoscopes, and bronchoscopic dispensable material, and specimens of cleaning solutions, cleaning brushes, the AER, and the ultrasound system were sent for bacterial culture. Medical records were reviewed to identify possible infections after a bronchoscopy. Results: P. putida and S. maltophilia were isolated from BW samples of

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Caveat Emptor: The Role of Suboptimal Bronchoscope Repair Practices by a Third-Party Vendor in a Pseudo-Outbreak ofPseudomonasin Bronchoalveolar Lavage Specimens

Abstract: Objective.To describe a pseudo-outbreak associated with loose bronchoscope biopsy ports caused by inadequate bronchoscope repair practices by third-party vendors and to alert healthcare personnel to assess bronchoscope repair practices.Design.Outbreak investigation.Setting. Show more

Cited by 14 publications

References 14 publications

Outbreak of pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia infections related to contaminated bronchoscope suction valves, Lyon, France, 2014

Outbreak of pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia infections related to contaminated bronchoscope suction valves, Lyon, France, 2014

Investigation of a Candida guilliermondii Pseudo-outbreak Reveals a Novel Source of Laboratory Contamination

A Pseudo-Outbreak of <b><i>Pseudomonas putida</i></b> and <b><i>Stenotrophomonas maltophilia</i></b> in a Bronchoscopy Unit

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