Residual moisture and waterborne pathogens inside flexible endoscopes: Evidence from a multisite study of endoscope drying effectiveness

A Systematic Review of Disposable Sheath Use During Flexible Endoscopy

“…In the studies we reviewed, reported microbial growth levels were low (ie, less than 8%), possibly because of inadequate sampling and microbial culture methods or a general focus on shorter, less complex endoscopes that are less likely to retain contamination. Primary studies on reprocessing effectiveness conducted by our research team have found contamination rates exceeding 50% when robust sampling and testing methods were used . Based on our study findings, results recently reported by others, and our experience with microbial culturing, we are concerned that the low rates of microbial growth reported in the reviewed sheath studies may have been because of sampling and testing methods that were insufficient to detect contamination.…”

Potential impact of contaminated bronchoscopes on novel coronavirus disease (COVID-19) patients

“…Ofstead et al [7][8][9] have conducted prospective studies that evaluated effectiveness of bronchoscope reprocessing in 5 hospitals in the United States. Microbial growth was detected on 23 of 35 bronchoscopes (65.7%), and 10 bronchoscopes (28.6%) harbored high-concern organisms or actionable levels of microbial growth (>100 CFU) ( Table 1).…”

“…Microbial growth was detected on 23 of 35 bronchoscopes (65.7%), and 10 bronchoscopes (28.6%) harbored high-concern organisms or actionable levels of microbial growth (>100 CFU) ( Table 1). [7][8][9] Mold and gram-negative bacteria were detected, including S. maltophilia, Sphingomonas phyllosphaerae, and Escherichia coli/Shigella. At one hospital, high protein levels were detected in 7 of 8 bronchoscopes, indicating that manual cleaning failed to remove soil.…”

“…7,8 Audits evaluating personal protective equipment use and reprocessing guideline adherence (eg, point-ofcare precleaning; leak testing; manual cleaning; visual inspection; cleaning verification; high-level disinfection; rinsing; drying; storage; transport and handling) identified breaches in all 5 hospitals. [7][8][9] Technicians in 2 hospitals (sites 1 and 5) performed most reprocessing steps correctly, but bronchoscopes at both sites harbored S. maltophilia due to contaminated rinse water. 7,9 In 3 hospitals (sites 2-4), nearly all steps were performed incorrectly or were skipped entirely.…”

“…7,9 In 3 hospitals (sites 2-4), nearly all steps were performed incorrectly or were skipped entirely. 7,8 In light of these breaches and observations that most bronchoscopes were damaged and contaminated, a recommendation was made that procedures in 2 hospitals be halted until strict protocols could be implemented and personnel retrained. In addition, it was recommended that badly damaged bronchoscopes be removed from service and replaced with single-use, sterile bronchoscopes or new reusable bronchoscopes constructed with sterilizable materials.…”