Effectiveness of Reprocessing for Flexible Bronchoscopes and Endobronchial Ultrasound Bronchoscopes Q&A With Author Cori L. Ofstead, MSPH

By: Vanessa Claude

November 29, 2018

What effect do you hope the findings of this study will have on flexible bronchoscope reprocessing methods?

This study found that the methods used in three hospitals to clean and disinfect bronchoscopes were not effective, in part because crucial steps were being skipped or done improperly. I hope the study serves as a wake-up call to pulmonologists, the teams of reprocessing, and infection prevention personnel who are responsible for ensuring that reusable instruments are safe for use. More stringent reprocessing is clearly necessary, and I hope the American College of Chest Physicians® will take the lead on developing stronger guidelines, training programs, and quality management systems that reduce patient exposure.

What are some factors that could enhance this study further?

Although we found microbial growth in 58% of bronchoscopes, the proportion with growth was likely underestimated because the incubation period was only 5 to 7 days, and we did not use methods needed to identify Mycobacterium or viruses. Future studies should address this and include sufficient resources to support identification of all microbial growth.

More importantly, the clinical implications of our findings are unknown because we did not track patient outcomes. Research is needed to evaluate the link between contaminated bronchoscope use and outcomes. This could be done via a randomized trial that involves sampling both patients and bronchoscopes. Samples obtained during procedures with reprocessed bronchoscopes could be compared with procedures done with single-use sterile bronchoscopes. Alternately, baseline samples could be obtained using a sterile disposable bronchoscope for comparison with samples obtained using a reusable bronchoscope in the same patient.

How would you overcome some of the limitations of this study moving forward?

Multisite studies are needed to define the extent of the problem and determine the effectiveness of potential solutions. The involvement of multidisciplinary teams including pulmonologists, epidemiologists, infection preventionists, and frontline sterile processing personnel will be essential.

Are there any findings that you’d like to expand on in the future? What results would you like to find?

We would like to determine how GI bugs (eg, E. coli/Shigella) got inside bronchoscopes. We believe that reprocessing bronchoscopes in the same sinks and automated endoscope reprocessing systems (AERs) used for colonoscopes and gastroscopes could have introduced these pathogens. If it turns out that contaminated sinks and AERs are contributing to the problem, more rigorous protocols for their decontamination will be needed.

Read the full article: Effectiveness of Reprocessing for Flexible Bronchoscopes and Endobronchial Ultrasound Bronchoscopes

Cori Ofstead, MSPH, is an epidemiologist who specializes in developing and conducting real-world studies to evaluate the impact of clinical processes on outcomes. Her research interests include health-care–associated infections, injuries, and radiation exposure. She is also interested in the interface between medical technology and human factors that impact clinical decision-making and practices.

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