OR Manager - September 2019 - 12

Patient safety
Bronchoscopes
Continued from page 1
out the difference in costs for highlevel
disinfection (HLD), sterilization,
and single-use. They performed a cost
study at four additional hospitals.
Reprocessing study at three
hospitals
The bronchoscope reprocessing study
was performed at three prestigious hospitals
that were " top-notch " in terms of
their programs, Ofstead says. They were
using bronchoscopes in extremely vulnerable
patients, many of whom either
had a transplant or needed a transplant.
Ofstead and her team tested each of
the sites' bronchoscopes after they had
been used in procedures and manually
cleaned, and they tested them again
after HLD. The tests assessed the presence
of hemoglobin, proteins, and adenosine
triphosphate (ATP), which indicates
there are still cells remaining
from secretions or bacteria. Next, they
performed cultures to look for soil and
viable microbes.
After the laboratory tests, they did
visual inspections, looked at the bronchoscopes
with magnification on the
outside, and used borescopes to examine
the inside. They also assessed the
storage cabinets where the bronchoscopes
were kept, and they audited the
reprocessing practices.
Ultimately, Ofstead and her team
assessed 24 bronchoscopes that
were used clinically and two that were
brand new and still in their shipping
containers.
All of the clinically used bronchoscopes
still had soil on them after
cleaning, and all of them had visible
irregularities after HLD, which included
scratches and retained fluid or residue
that was brown, red, or oily. They also
found a number of damaged insertion
tubes and distal ends as well as a lot of
filamentous debris in the channels.
12
OR Manager | September 2019
Overview of adherence to current endoscope reprocessing
guidelines
Site
Reprocessing step
Bedside preclean
Dirty-to-clean workflow
Leak test
Manual clean
Visual inspection
Cleaning verification
High-level disinfection and rinsing
Drying
Storage
Transport and handling
Personal protective equipment use
A
-
ü
ü
ü
-
ü
ü
ü
ü
ü
ü
B
ü
-
-
-
-
-
-
-
-
-
-
C
-
-
-
-
-
-
-
-
-
-
-
Adapted from Ofstead C L, Quick M R, Wetzler H P, et al. Effectiveness of reprocessing
for flexible bronchoscopes and endobronchial ultrasound bronchoscopes.
Chest. 2018;154(5):1024-1034. Used with permission.
ü met current guidelines; - did not meet current guidelines.
" Given that 100% of the scopes
were still dirty and 100% of them had
visible defects, it's not surprising that
HLD failed, " Ofstead says. Overall, 58%
of the time, the bronchoscopes had viable
microbes still on them after they
were fully processed.
Ofstead notes that this finding was
" sobering in part because of the nature
of what was found. " Inside of the
bronchoscopes were Stenotrophomonas
maltophilia, which is a water-borne
pathogen that tends to be carbapenemresistant,
and Escherichia coli, Shigella
species, which causes dysentery.
" Finding these in bronchoscopes is
not good, " says Ofstead. " It introduces
the possibility that
the reprocessing
methods used were introducing new
contaminants. "
Contamination
Because high contamination levels were
found at all of the study sites, and they
all used the same automated endoscope
reprocessors (AERs), Ofstead says they
questioned whether the facilities had contaminated
sinks or contaminated AERs.
Another factor that led to this questioning
was that brand new bronchoscopes,
which had extremely low contamination
levels when they took them
out of their shipping containers, had
higher contamination levels after reprocessing.
After
manual cleaning, the amount
of protein on one bronchoscope quadrupled,
and they found bacteria that
weren't present before it was reprocessed-even
though the bronchoscope
had never been used in a patient
procedure.
Only one of the three sites had the E
coli, Shigella, but that site had the worst
levels of contamination throughout and
the worst reprocessing practices, she
says. In addition, they were using damaged
bronchoscopes (sidebar above).
The storage cabinets at two sites
also were visibly dirty, and testing found
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