Effectiveness of Reprocessing for Flexible Bronchoscopes and Endobronchial Ultrasound Bronchoscopes
Effectiveness of Reprocessing for Flexible Bronchoscopes and Endobronchial Ultrasound Bronchoscopes
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DOI：
10.1016/j.chest.2018.04.045
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发表时间：
2018-11-01
期刊：
影响因子：
9.6
通讯作者：
Ferguson, J. Scott
中科院分区：
文献类型：
--
作者：
Ofstead, Cori L.;Quick, Mariah R.;Ferguson, J. Scott
背景技术背景：感染与再处理不充分的柔性支气管镜有关，最近的调查确定，即使支气管镜清洁和消毒实践符合现行指南，也会发生病原体传播。本多中心前瞻性研究评估了真实世界支气管镜再处理方法的有效性，采用系统方法：本研究涉及直接观察柔性支气管镜的再处理方法，手动清洁后和高水平消毒后进行多方面评价，并评估储存条件。使用照明放大镜和管道镜对端口和通道进行目视检查。使用微生物培养物和蛋白质、血红蛋白和三磷酸腺苷（ATP）检测污染。研究人员评估了再处理的做法，并通过目视检查和ATP tests.RESULTS评价储存柜的清洁度：研究人员检查了24个临床使用的支气管镜。手动清洁后，100%的支气管镜有残留污染。在14个完全再处理的支气管镜（58%）中发现微生物生长，包括霉菌、嗜麦芽窄食单胞菌和大肠埃希菌/志贺氏菌属。在100%的支气管镜中观察到可见的不规则性，包括滞留液体;棕色、红色或油性残留物;划痕;插入管和远端损坏;通道中的丝状碎片。在三个站点中的两个站点，再处理实践不合格。结论：所有站点都在使用损坏和污染的支气管镜。再处理实践不当可能导致在支气管镜上发现生物负载。然而，即使遵循指南，高水平消毒也无效。建议改用无菌支气管镜。与此同时，需要质量管理计划和更新的再处理指南。
BACKGROUND: Infections have been linked to inadequately reprocessed flexible broncho-scopes, and recent investigations determined that pathogen transmission occurred even when bronchoscope cleaning and disinfection practices aligned with current guidelines. This multisite, prospective study evaluated the effectiveness of real-world bronchoscope reprocessing methods, using a systematic approach.METHODS: This study involved direct observation of reprocessing methods for flexible bronchoscopes, multifaceted evaluations performed after manual cleaning and after high-level disinfection, and assessments of storage conditions. Visual inspections of ports and channels were performed using lighted magnification and borescopes. Contamination was detected using microbial cultures and tests for protein, hemoglobin, and adenosine triphosphate (ATP). Researchers assessed reprocessing practices, and storage cabinet cleanliness was evaluated by visual inspection and ATP tests.RESULTS: Researchers examined 24 clinically used bronchoscopes. After manual cleaning, 100% of bronchoscopes had residual contamination. Microbial growth was found in 14 fully reprocessed bronchoscopes (58%), including mold, Stenotrophomonas maltophilia, and Escherichia coli/Shigella species. Visible irregularitieswere observed in 100% of bronchoscopes, including retained fluid; brown, red, or oily residue; scratches; damaged insertion tubes and distal ends; and filamentous debris in channels. Reprocessing practices were substandard at two of three sites.CONCLUSIONS: Damaged and contaminated bronchoscopes were in use at all sites. Inadequate reprocessing practices may have contributed to bioburden found on bronchoscopes. However, even when guidelines were followed, high-level disinfection was not effective. A shift toward the use of sterilized bronchoscopes is recommended. In the meantime, quality management programs and updated reprocessing guidelines are needed.