Contamination of single‐use bronchoscopes in critically ill patients

Abstract

SummaryDisposable bronchoscopes such as the Ambu aScope TM 3 are marketed as 'single use' The risks of contamination from prolonged device storage before possible re-use are unknown. Following clinical bronchoscopy in patients whose lungs were mechanically ventilated, 20 aScope TM 3's bronchoscopes received a standard 'social clean' and were then stored. Subsequent paired saline flush and swab samples were taken at time zero, and at 24 h and 48 h. Positive microbiological cultures were obtained from at least one time point from 16 of the 20 bronchoscopes. Pathogens considered at high risk of causing pneumonia were isolated from seven bronchoscopes, with significant quantities from six of them. Our study demonstrates that aScope TM 3's should not be re-used on the same patient, as clinically significant growth of micro-organisms occurs frequently, despite adequate social cleaning. Culture of bronchoscopes themselves may be a potentially useful diagnostic tool in the context of pulmonary infection. Our data make it clear that these devices are single use and not single patient use.

Design counsel: the role of clinicians in the prototyping and standard setting of anaesthetic equipment

“…However, even less is known about the practice of re-using singleuse devices in the same patient. In this edition of Anaesthesia, McGrath and colleagues have published their very practical test of potential harm from 'same patient' re-use of the Ambu aScope3 TM (Ambu Ltd, St Ives, Cambridgeshire, UK) single-use bronchoscope device [3]. They demonstrated a consistent ability of pathogenic bacteria to withstand standard bedside cleaning, and clearly showed that re-interpreting 'singleuse' devices, as 'single-patient' devices is dangerous, particularly when the time between procedures on that single patient is extended.…”

“…We also note that many scientific journals favour systematic reviews because they tend to contribute to higher journal impact factors. However, the rise of systematic reviews should give cause for concern; more than 8000 are being indexed in MEDLINE annually, reflecting a three-fold increase over the last decade [3]. We write 'concern', because many of these reviews across healthcare seem to fall short of essential requirements such as incorporating risk of bias assessment in meta-analyses (only 16%), searching for unpublished data (only 7%), or not fully following a protocol (only one-third [3]).…”

“…However, the rise of systematic reviews should give cause for concern; more than 8000 are being indexed in MEDLINE annually, reflecting a three-fold increase over the last decade [3]. We write 'concern', because many of these reviews across healthcare seem to fall short of essential requirements such as incorporating risk of bias assessment in meta-analyses (only 16%), searching for unpublished data (only 7%), or not fully following a protocol (only one-third [3]). A recent study of reviews published in anaesthetic journals revealed similar shortfalls [4].…”

“…Despite their veneer of sophistication, one has to bear in mind that systematic reviews are, in essence, retrospective appraisals of the evidence. Editors, writers and readers should exercise great caution when interpreting conclusions of reviews that only include very few trials, even when they fulfill the required standards [3]. Despite great efforts to promote adequate quality of reviews through international guidelines such as PRISMA, GRADE and the Cochrane Handbook [8], the majority of reviews may suffer from threats to the validity of their findings due to risk of systematic errors (bias), design errors (i.e., erroneous selection of patients, doses of medication, comparators, analyses, outcomes) and random error (play of chance) [9].…”

“…© 2016 The Association of Anaesthetists of Great Britain and Ireland Anaesthesia 2017, 72,[3][4][5][6][7][8][9][10][11][12][13][14][15][16] Editorial…”