Pseudo-outbreak of Pseudomonas aeruginosa in HIV-infected Patients Undergoing Fiberoptic Bronchoscopy

Kolmos, Hans Jørn; Lerche, Axel; Kristoffersen, K.; Rosdahl, Vibeke Thamdrup

doi:10.3109/00365549409008632

Cited by 32 publications

(18 citation statements)

References 14 publications

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“…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%

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: Bacteriamentioning

confidence: 99%

Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

et al. 2013

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“…76 " 78 To ensure that persons responsible for reprocessing are properly trained, there should be initial and annual competency testing for such personnel. Siegman-lgra et al 40 Richardson et al 41 Hoffmann etal 42 Wheeler et al 31 Nye et al 43 Fraser et al 45 Gubleretal 46 Nicolle et al 47 Whitlock et al 48 Bryce et al 49 Vandernbroucke-Grauls et al 50 Bennett et al 51 Campagnaro et al 52 Kolmos et al 53 Maloney et al 54 Petersen et al 55 Hagan et al 56 Takigawa et al 57 Wang et al 58 Mitchell et al 59 Wallace …”

Section: O S O C O M I a L O U T B R E A K S Via B R O N C H O S C O mentioning

confidence: 99%

Lessons From Outbreaks Associated With Bronchoscopy

Weber

Rutala

2001

Infect. Control Hosp. Epidemiol.

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“…This article's review of the medical literature presents a number of additional findings. First, it identified several reports that document outbreaks (and pseudo-outbreaks) of P. aeruginosa associated with a number of different types of reusable medical instruments, including bronchoscopes, gastrointestinal endoscopes and transrectal ultrasound-guided prostate biopsy equipment [9][10][11][12][13][14][15][16][17]. These instruments, however, unlike the arthroscopic shaver handpieces and inflow/outflow cannulae discussed by Tosh et al (2011), are damaged by heat, and for each of these reported outbreaks disease transmission was linked, not to ineffective steam sterilization, but to inadequate high-level disinfection or liquid chemical sterilization.…”

Section: Methodsmentioning

confidence: 99%

“…Outbreaks of P. aeruginosa have been associated with the improper reprocessing of flexible endoscopes, often due to their terminal rinsing with contaminated water following high-level disinfection or liquid chemical sterilization [9][10][11][12][13][14][15][16][17][18]. Yet, improper reprocessing of reusable medical equipment-whether of a flexible endoscope, an arthroscopic instrument, or another type of medical instrument-is but only one of many factors documented to be responsible for infections of P. aeruginosa in the healthcare setting.…”

Section: Contaminated Surfaces Handsmentioning

confidence: 99%

“…3) The unwitting and unrecognized failure to have terminally sterilized the implicated arthroscopic instruments using any method [31]; 4) Ineffective sterilization of the implicated arthroscopic instruments due to a deficiency or unrecognized fault in one or more of the hospital's sterilization processes; 5) Immersion of the implicated arthroscopic equipment in a liquid chemical disinfectant or sterilant, followed by its rinsing with water contaminated with the outbreak's strain of P. aeruginosa [9,10,12,[15][16][17]; and/or 6) A factor unrelated to the reprocessing of the hospital's implicated arthroscopic instruments-for example, the possibility that the outbreak's strain of P. aeruginosa might have originated from a source hitherto not identified, such as an intrinsically contaminated irrigant used during the procedures, or due to retrograde flow from a contaminated suction canister [1]. steps."…”

Section: Re-contamination After Sterilization?mentioning

confidence: 99%

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Other Possible Causes of a Well-Publicized Outbreak of <i>Pseudomonas aeruginosa</i> Following Arthroscopy in Texas

Muscarella¹

2013

AID

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Background: Seven patients at a hospital in Houston, TX, were diagnosed during a two-week period in 2009 with joint space infection of pansusceptible P. aeruginosa following arthroscopic procedures of the knee or shoulder. Tosh et al. (2011), who investigated and published the principal report discussing this bacterial outbreak, conclude that its most likely cause was the improper reprocessing of certain reusable, physically-complex, heat-stable arthroscopic instruments used during these arthroscopic procedures. These reusable instruments reportedly remained contaminated with remnant tissue, despite diligent efforts by the hospital to clean their internal structures. This retained bioburden presumably shielded the outbreak's strain of embedded P. aeruginosa from contact with the pressurized steam, reportedly resulting in ineffective sterilization of these arthroscopic instruments and bacterial transmission. Objectives: First, to clarify which specific sterilization methods, in addition to steam sterilization, Methodist Hospital employed to process its reusable arthroscopic instrumentation at the time of its outbreak, in 2009; second, to evaluate Tosh et al.'s (2011) conclusion that ineffective steam sterilization due to inadequate cleaning was the most likely cause of this hospital's outbreak; third, to consider whether any other hitherto unrecognized factors could have plausibly contributed to this outbreak; and, fourth, to assess whether any additional recommendations might be warranted to prevent disease transmission following arthroscopic procedures. Methods: The medical literature was reviewed; some of the principles of quality assurance, engineering and a root-cause analysis were employed; and Tosh et al.'s (2011) findings and conclusions were reviewed and compared with those of other published reports that evaluated the risk of disease transmission associated with the steam sterilization of physically-complex, heat-stable, soiled surgical instruments. Results and Conclusion: Reports documenting outbreaks of P. aeruginosa or another vegetative bacterium associated with the steam sterilization of inadequately cleaned surgical or arthroscopic instruments are scant. This finding-coupled with a number of published studies demonstrating the effective steam sterilization of complex instruments contaminated with vegetative bacteria mixed with organic debris, or, in one published series of tests, with resistant bacterial endospores coated with hydraulic fluid-raises for discussion whether Methodist Hospital's outbreak might have been due to one or more factors other than, or in addition to, that which Tosh et al. (2011) conclude was its most likely cause. An example of such a factor not ruled out by Tosh et al. (2011) findings would be the re-contamination of the implicated arthroscopic instruments after sterilization. The specific methods that Methodist Hospital employed at the time of its outbreak to sterilize some of its arthroscopic instrumentation remain unclear. A number of additional recommendatio...

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Pseudo-outbreak of Pseudomonas aeruginosa in HIV-infected Patients Undergoing Fiberoptic Bronchoscopy

Cited by 32 publications

References 14 publications

Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

Lessons From Outbreaks Associated With Bronchoscopy

Other Possible Causes of a Well-Publicized Outbreak of <i>Pseudomonas aeruginosa</i> Following Arthroscopy in Texas

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Pseudo-outbreak of Pseudomonas aeruginosa in HIV-infected Patients Undergoing Fiberoptic Bronchoscopy

Cited by 32 publications

References 14 publications

Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

Lessons From Outbreaks Associated With Bronchoscopy

Other Possible Causes of a Well-Publicized Outbreak of &lt;i&gt;Pseudomonas aeruginosa&lt;/i&gt; Following Arthroscopy in Texas

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Other Possible Causes of a Well-Publicized Outbreak of <i>Pseudomonas aeruginosa</i> Following Arthroscopy in Texas