Pseudo-Outbreak of<i>Pseudomonas aeruginosa</i>and<i>Serratia marcescens</i>Related to Bronchoscopes

Silva, Claudia V.; Magalhães, Vanda D.; Pereira, Crèsio Romeu; Kawagoe, Julia Yaeko; Ikura, Chizue; Ganc, Arnaldo José

doi:10.1086/502195

Cited by 44 publications

(31 citation statements)

References 9 publications

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“…Disinfectants with low potency do not destroy Mycobacterium tuberculosis, atypical mycobacteria, and bacterial spores. Concentration and exposure time of a disinfecting agent are crucial; inappropriate dilution and insufficient exposure can result in a failure of effective reprocessing (28)(29)(30). Inappropriate disinfectants with low and intermediate potency are not recommended for HLD and have been replaced by glutaraldehyde, hydrogen peroxide, ortho-phthalaldehyde, peracetic acid, and superoxidized and electrolyzed acid water (31,32).…”

Section: Relevance Of Cleaning and Disinfectionmentioning

confidence: 99%

“…According to the Guideline Committee of the European Society of Gastrointestinal Endoscopy, sterile water is preferable for the final rinse to prevent recontamination (5). Many outbreaks of endoscopy-related infections and cross-contaminations due to P. aeruginosa, Serratia marcescens, M. chelonae, Mycobacterium xenopi, and Methylobacterium mesophilicum have been related to rinsing flexible endoscopes after disinfection with nonsterile tap water (30,(51)(52)(53)(54)(55)(56)(57). The accepted procedures to produce bacterium-free water in disinfectors for endoscopes include filtration, UV radiation, or heating followed by cooling (5).…”

Section: Relevance Of Cleaning and Disinfectionmentioning

confidence: 99%

“…Many outbreaks of P. aeruginosa infection after GI endoscopy and bronchoscopy have been associated with inadequate cleaning and the use of inappropriate intermediate-level and low-level disinfectants (29,62,64,73,80,90,(95)(96)(97)(98), contaminated endoscope water bottles and the water supply to the endoscope (29,65,90,99,100), and drying of endoscope channels with no flushing with 70% ethanol after disinfection (22,30,70,(73)(74)(75) or lack of a drying procedure (26,64) (Tables 2 to 5). Two recent outbreaks of multidrug-resistant P. aeruginosa post-ERCP infections have been related to the remaining contamination of the endoscope despite accurate reprocessing followed by negative surveillance endoscope cultures (2,101).…”

Section: Bacteriamentioning

confidence: 99%

“…Many health care-associated S. marcescens outbreaks have been related to inadequate disinfection and drying procedures (30,55,57,72,141,142) and rinsing of endoscope channels with nonsterile tap water after disinfection (30,55,57) (Tables 4 and 5). A postbronchoscopic outbreak involved 117 patients who were colonized with different Enterobacteriaceae and was associated with two specific bronchoscopes contaminated with Klebsiella pneumoniae and Proteus vulgaris (143).…”

Section: Bacteriamentioning

confidence: 99%

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Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

et al. 2013

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SUMMARY Flexible endoscopy is a widely used diagnostic and therapeutic procedure. Contaminated endoscopes are the medical devices frequently associated with outbreaks of health care-associated infections. Accurate reprocessing of flexible endoscopes involves cleaning and high-level disinfection followed by rinsing and drying before storage. Most contemporary flexible endoscopes cannot be heat sterilized and are designed with multiple channels, which are difficult to clean and disinfect. The ability of bacteria to form biofilms on the inner channel surfaces can contribute to failure of the decontamination process. Implementation of microbiological surveillance of endoscope reprocessing is appropriate to detect early colonization and biofilm formation in the endoscope and to prevent contamination and infection in patients after endoscopic procedures. This review presents an overview of the infections and cross-contaminations related to flexible gastrointestinal endoscopy and bronchoscopy and illustrates the impact of biofilm on endoscope reprocessing and postendoscopic infection.

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Section: Relevance Of Cleaning and Disinfectionmentioning

confidence: 99%

Section: Relevance Of Cleaning and Disinfectionmentioning

confidence: 99%

Section: Bacteriamentioning

confidence: 99%

Section: Bacteriamentioning

confidence: 99%

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Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

et al. 2013

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“…To date, countless P. aeruginosa nosocomial outbreaks have been described that were caused by patient-topatient transmission, environmental sources, or contaminated medical devices (5,(8)(9)(10). P. aeruginosa also has been reported as a cause of pseudo-outbreaks due to the contamination of media used for clinical specimen collection, transport, or analysis (6,12,13).…”

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confidence: 99%

Pseudo-Outbreak of Extremely Drug-Resistant Pseudomonas aeruginosa Urinary Tract Infections Due to Contamination of an Automated Urine Analyzer

et al. 2012

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By the end of May 2010, an increase in the number of urine specimens that were culture positive for extremely drug-resistant (XDR) Pseudomonas aeruginosa was observed in our 800-bed university hospital. This led to an infection control alert. No epidemiological link between the patients and no increase in the frequency of XDR P. aeruginosa in non-urine samples were observed. Therefore, a pseudo-outbreak due to analytical contamination in the laboratory was rapidly suspected. A prospective and retrospective search of cases was initiated, and the sampling of the automated urine analyzers used in the laboratory was performed. Antibiotypes were determined by disc diffusion, and genotypes were determined by pulsed-field gel electrophoresis (PFGE). From February to July 2010, 17 patients admitted to 12 different departments and 6 outpatients were included. The mixing device of the cytometric analyzer used for the numeration of urinary particles (Sysmex UF1000i) proved to be heavily contaminated. Isolates recovered from 12 patients belonged to the same antibiotype and PFGE type as the isolate recovered from the analyzer. Extensive disinfection with a broad-spectrum disinfectant and the replacement of the entire tubing was necessary to achieve the complete negativity of culture samples taken from the analyzer. A pseudo-outbreak caused by an XDR P. aeruginosa clone was proven to be due to the contamination of the cytometric analyzer for urinary sediment. Users of such analyzers should be aware that contamination can occur and should always perform culture either before the processing of the urine sample on the analyzer or on a distinct sample tube. Pseudomonas aeruginosa is a Gram-negative aerobic rodshaped bacterium that inhabits a wide range of environments, such as water, soil, the rhizosphere, and animals (11). It also is known as a frequent opportunistic pathogen in both animals and humans. Due to its potential for developing resistance against multiple antibiotic and antiseptic compounds, P. aeruginosa also has emerged as a major, difficult-to-treat nosocomial pathogen. P. aeruginosa is an important cause of morbidity and mortality in high-risk patients, such as immunosuppressed, cystic fibrosis, burn, cancer, and ventilated intensive care patients (11). To date, countless P. aeruginosa nosocomial outbreaks have been described that were caused by patient-topatient transmission, environmental sources, or contaminated medical devices (5,(8)(9)(10). P. aeruginosa also has been reported as a cause of pseudo-outbreaks due to the contamination of media used for clinical specimen collection, transport, or analysis (6, 12, 13).The Sysmex UF1000i is an automated fluorescence flow cytometer used to count and classify cells and particles in urine samples. This automated system, which has been used in our 800-bed university hospital laboratory since January 2010, is established as a rapid and sensitive screening method with high negative predictive value which avoids the unnecessary culture of negative urine samples and presen...

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Infection Control and Radiation Safety in the Bronchoscopy Suite

Jain

Hadique

Mehta

2020

Flexible Bronchoscopy

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Pseudo-Outbreak ofPseudomonas aeruginosaandSerratia marcescensRelated to Bronchoscopes

Abstract: Prevention of pseudo-outbreaks requires meticulous use of preventive measures for infection-prone medical procedures.

Cited by 44 publications

References 9 publications

Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

Pseudo-Outbreak of Extremely Drug-Resistant Pseudomonas aeruginosa Urinary Tract Infections Due to Contamination of an Automated Urine Analyzer

Infection Control and Radiation Safety in the Bronchoscopy Suite

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