Action Required: Preventing Infection Transmitted Through Bronchoscopes

An association between cleaned and high-level disinfected duodenoscopes and cases of carbapenem-resistant Enterobacteriaceae (CRE) and related multidrug-resistant organisms (MDROs) has recently garnered attention. This has left pulmonologists and other stakeholders questioning the current standards for reprocessing flexible bronchoscopes. Researchers in this study conducted a review to address related concerns and determine the potential harm associated with reprocessed bronchoscopes and infections caused by CRE and related MDROs. Current literature, the Food and Drug Administration’s medical device database of adverse events, and the Internet were queried back to 2012, at which time it was established that endoscopy could be considered a risk factor for spreading CRE. A total of 12 cases evaluating a relationship between reprocessed bronchoscopes and infections due to CRE or related MDROs were identified, of which eight were based in the United States. The evidence pointed to a significant yet underpublicized risk associated with bronchoscopes and CRE and related MDROs transmissions. Despite cleaning instructions per the manufacturers of bronchoscopes, these measures may not be enough to mitigate the risk of CRE and related MDROs transmissions. Using a damaged or improperly serviced bronchoscope was considered a significant risk factor.  The study authors recommended that stronger preventative measures and revised reprocessing guidance be developed. The study author’s recommendations include adding sterilization to reprocessing and a strict adherence to manufacturer guidelines. Read more