OR Manager - September 2019 - 16

Patient safety
Continued from page 15
Mehta A C, Gildea T. Burying our
heads in the sand: Cross-contamination
during bronchoscopy.
CHEST. 2018;154(5):1001-1003.
Mehta A C, Gildea T. Editorial. CHEST.
2019;155(6):1301.
Mehta A C, Prakash U B S, Garland
R, et al. American College of
Chest Physicians and American
Association for Bronchology
Consensus Statement: Prevention
of Flexible BronchoscopyAssociated
Infection. CHEST.
2005;128(3):1742-1755.
Ofstead C L, Heymann O L, Quick M
R, et al. Residual moisture and
waterborne pathogens inside flexible
endoscopes: Evidence from a
multisite study of endoscope drying
effectiveness. Am J Infect Control.
2018;46:689-696.
Ofstead C L, Heymann O L, Quick
M R, et al. The effectiveness of
sterilization for flexible ureteroscopes:
A real-world study. Am J
Infect Control. 2017;45(8):888895.
Ofstead
C L, Hopkins K M, Eiland J E,
et al. Managing bronchoscope quality
and cost: Results of a real-world
study. IAHCSMM Process. March/
April 2019; pp 63-71. https://www.
ambu.com/Files/Files/Ambu/Investor/News/English/2019/Managing%20Bronchoscope%20cost%20
a%20real%20world%20study.pdf.
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.
Ofstead C L, Wetzler H P, Eiland
J E, et al. Editorial. CHEST.
2019:155(6):1300.
Shulimzon T, Chatterji S, Gan R.
Infections and damaged flexible
bronchoscopes: Time for
a change (Editorial). CHEST.
2019;155(6):1299.
All Facts Considered.....
This article by Judith M. Mathias, MA, RN, on
the research by Cori L. Ofstead, MSPH, and
colleagues proves that there is no dearth of
evidence to substantiate that the procedure
of bronchoscopy can spread " true " infection.1
Emerging data also warn us that these infections
could involve virulent organisms such as
carbapenum-resistant Enterococci and could
lead to lethal consequences.
One more fact that needs to be emphasized
is that such complications can take place despite
adhering precisely to the manufacturers'
guidelines on disinfecting the instrument.2
So what is the take-home point?
Obviously, there is no room for smugness
while performing bronchoscopy. And as I see
it, there is lots of room for improvement, and
a team effort is required.
In my strongest opinion, to begin with, the
bronchoscopist should be ultimately held
responsible for the cleanliness and maintenance
of the instrument.
Every bronchoscopist must be adequately
trained with the process of disinfecting the
instrument before learning the procedure. The
process of disinfection should be standardized
by creating simulators similar to those for the
most popular procedures.3
16
OR Manager | September 2019
Availability and ease of the procedure
should influence neither its diagnostic nor
therapeutic indications.4 This recommendation
remains of vital importance with the
increasing popularity of the subspecialty of
interventional pulmonology.5
In addition, a great deal of caution must
be practiced with the miniaturization of the
instrument because the scopes with the narrower
channels are difficult to clean.
And lastly, it is high time for reconnaissance
of bronchoscopy-related infections.
Institutions should establish affordable
and practical protocols for culturing bronchoscopes
and for borescope inspections.
Similarly, protocols to rule out subclinical
bacteremia and mediastinitis following the
procedure should also be established.6
Sterilization of the instrument and use of
a disposable bronchoscope are ostensible
options, yet the intricacy of the instrument
as well as its applications make them far
from reality.
Atul C. Mehta, MD, is Professor
of Medicine and Buoncore
Family Endowed Chair in Lung
Transplantation, Respiratory
Institute, Cleveland Clinic,
Cleveland, Ohio.
References
1. Mehta A C, Prakash U B S, Garland R, et
al. American College of Chest Physicians
and American Association for Bronchology
Consensus Statement: Prevention of Flexible
Bronchoscopy-Associated Infection. CHEST.
2005;128(3):1742-1755.
2. Mehta A C, Muscarella L F. Special features:
Bronchoscope related " Superbug "
infections. CHEST. 2019 (in press)
3. Ost D, DeRosiers A, Britt J, et al. Assessment of
a bronchoscopy simulator. Am Rev Resp and
Crit Care Med. 2001:164(12):2248-2255.
4. Deshwal H, Avasarla S, Ghosh S, et al.
Special features: Forbearance with bronchoscopy:
A review of gratuitous indications.
CHEST. 2019;155(4):834-847.
5. Jain P, Mehta A C. Non-interventional
pulmonology: Birth of a new sub-specialty
with emergence of interventional
pulmonology. J Bronchology Interv
Pulmonol. 2017;24(1): 1-3.
6. Vaidya P J, Munavvar M, Leuppi J D, et al.
Endobronchial ultrasound-guided transbronchial
needle aspiration: Safe as it sounds.
Respirology. 2017;22(6):1093-1101.
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