Are You Doing All You Can to Prevent Bronchoscope Infection?
Increase in Bronchoscope-Related HAI on the Rise:
An increased frequency of infections caused by bronchoscopes contaminated by multidrug-resistant P. aeruginosa and Klebsiella pneumoniae have been published during the past few years (ICT, CDC.gov, NCBI.nlm.nih.gov). These recent outbreaks of HAI’s prompted the FDA to issue an official Safety Communication about microbial transmission and infection associated with bronchoscopes and bronchoscope infection rates.
As emphasized by the FDA, any kind of endoscopy must adhere to strict sterilization process guidelines, which stress that inadequate cleaning may result in the failure to reach sterilization and create a high-risk for infection transmission. The recent rise in bronchoscope infection rates can be traced to a lack of adherence to these strict sterilization process guidelines.
Patients exposed to bronchoscopy are already considered at a high risk of infection as many are critically ill or in an immunosuppressed state. Improper sanitation protocol heightens the danger to patients who are exposed to ripe conditions for an HAI to occur.
What challenges are adding to bronchoscope infection rates?
The answer probably won’t surprise you: it starts with the simple fact that bronchoscopy is a messy job. In addition to inserting foreign equipment into a patient’s body, these procedures often deal with biological substances like draining puss, blood and other fluid secretions. As a result, these scopes are exposed to a wide range of dangerous infectious substances. Couple this with the fact that many of these procedures are performed in outpatient facilities, and the considerable risk of cross-contamination and HAI’s rises dramatically.
Another more complicated and nuanced answer comes as a criticism of sterilization standards and the methods used to achieve those standards in many healthcare facilities as several independent studies have found a breakdown in both adherence to these protocols, and fault in the protocol itself (CDC.gov, NCBI.nlm.nih.gov).
Bronchial endoscopes are sensitive instruments that require delicate and specialized disinfection. Most flexible bronchoscopes cannot be steam sterilized and can be damaged by alternative sterilization methods. As a result, bronchoscope cleaning protocols are complex and involve many steps, leaving room for operator error or worse. These damaged devices have an increased bioburden due to aberrations and other forms of material degradation, which can be exacerbated by bleach, alcohol and other disinfectants. These worn surfaces contain pits and crevices for dangerous bacteria to hide in, increasing the bronchoscope’s bioburden with each use. What’s more, many bronchoscopes are black, meaning visual inspection is challenging as biological residue can blend in, disguising a bronchoscope that may be far dirtier than it appears.
What can my facility do to prevent these outbreaks?
Disappointingly, many researchers have found through auditing both inpatient and ambulatory facilities that simple sloppiness and low standards for sterilization & storage are primarily at fault for these preventable bronchoscope infection outbreaks.
Get an Outside Biosafety Consultation
It is always going to be easier to address an issue when you are aware of the extent and the specifics of that issue. Even the most objective supervisor or administrator will be partially blinded to oversights and inconsistencies in their own facility. That’s why the CDC highly recommends that your facility undergo a full audit of the preparation, use, cleaning and storage of all devices that are used in any kind of patient or employee interaction (CDC.gov). Creating a proper sanitation gameplan will allow you to reduce cases of bronchoscope infection. An effective biosafety plan always starts at square one.
Upgrade Your Testing
Simple, objective testing for the presence of biofilm on a sterilized object is the simplest method for upgrading your facilities hygiene protocol. A simple-to-use and effective tool, such as an ATP monitor, which tests surfaces and devices for Adenosine Triphosphate, a substance present in all organic material, will empower your staff to uphold the standards of your biosafety plan.
Stick to your plan
Ensure that all cleaning and disinfecting protocols are being followed and tracked through reporting software. When dealing with nasty bugs and pathogens, it’s the details that mean the difference between your success and a dangerous outbreak. Strict, disciplined adherence to your biosafety plan, stringent testing methods, and clearly defined cleaning and storage protocol are all vital to keeping your patients, as well as your staff and yourself, safe from infection outbreak and transmission of dangerous pathogens.
GLOSSARY OF TERMS
- Endoscopy – a nonsurgical procedure using a camera-equipped device to investigate interior body functions
- Bronchoscopy – A variety of endoscopy that examines the lungs and respiratory system
- HAI (Healthcare Acquired Infection) – Infections patients get while receiving medical treatment in a healthcare facility. These types of infections are particularly dangerous as they often involve bacteria that are resistant to standard treatment, such as MRSA
- Sterilization – Any process that eliminates, removes, kills, or deactivates all forms of biological agents and life within a specified region or area, such as a surface of a medical device
- Disinfection – The process of cleaning a device or surface of specific dangerous microorganisms
- High-Level Disinfection (HLD) – The treatment of devices and surfaces that inhibits most viable microorganisms, rendering them inert
- Bioburden – The population of bacteria present and living on a surface that has not been sterilized
- Ambulatory HC – A healthcare setting wherein the patient receives care without the need for an overnight stay
- Inpatient HC – A healthcare setting wherein the patient is provided care that requires at least one overnight stay, such as hospitals and surgical centers
- ATP monitoring – Adenosine Triphosphate is a substance present in all organic material. ATP testing is a method of testing sterilization by measuring ATP levels on a given surface