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• W4245546486 abstract "We found the comments by Shulimzon and Chatterji insightful, and we agree that the presence of Stenotrophomonas maltophilia, Escherichia coli, and mold in patient-ready bronchoscopes in our study1Ofstead C.L. Quick M.R. Wetzler H.P. et al.Effectiveness of reprocessing for flexible bronchoscopes and endobronchial ultrasound bronchoscopes.Chest. 2018; 154: 1024-1034Google Scholar is particularly worrisome. The failure of reprocessing to completely remove exogenous contaminants is concerning, especially considering pathogens were detected in bronchoscopes even after reprocessing using superior techniques. Although Pseudomonas aeruginosa was detected in four bronchoscopes after manual cleaning, this pathogen was not found after high-level disinfection. As such, the proportion of fully reprocessed bronchoscopes with pathogens is not as high as their letter asserts. Our results are similar to findings in other published studies. S maltophilia has been found in bronchoscopes, gastroscopes, and colonoscopes that were reprocessed in accordance with guidelines in a large academic medical center.2Ofstead C.L. Doyle E.M. Eiland J.E. et al.Practical toolkit for monitoring endoscope reprocessing effectiveness: identification of viable bacteria on gastroscopes, colonoscopes, and bronchoscopes.Am J Infect Control. 2016; 44: 815-819Google Scholar That institution later reported that extended-spectrum beta-lactamase-producing Klebsiella pneumoniae transmitted to a gastroscope by an infected patient persisted through 12 reprocessing cycles and 9 uses in other patients.3England D. Houseman J. Horn L. Mascotti K. Kline S. Documented transmission of extended-spectrum Beta-lactamase-producing Klebsiella pneumoniae from patient to gastroscope.Infect Control Hosp Epidemiol. 2016; 37: 493-494Google Scholar Galdys et al4Galdys A.L. Marsh J.W. Delgado E. et al.Bronchoscope-associated clusters of multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae.Infect Control Hosp Epidemiol. 2019; 40: 40-46Google Scholar recently described a bronchoscopy-associated outbreak of carbapenem-resistant K pneumoniae and gentamicin-resistant P aeruginosa. Despite a lack of reprocessing breaches, outbreak strains were recovered from a bronchoscope, and visual examination of its channel with a borescope revealed defects and proteinaceous debris. Although attributable mortality was not assessed in this outbreak investigation, it is sobering to note that 10 of 19 patients exposed to the contaminated bronchoscope died. Bronchoscope durability and life span is likely a key component to successful reprocessing. As Shulimzon and Chatterji stated, we found 100% of bronchoscopes had visible defects. Manual cleaning may not sufficiently eliminate soil when bronchoscopes are damaged, adversely impacting the effectiveness of high-level disinfection. Therefore, it is essential to inspect bronchoscopes for damage, evaluate reprocessing practices, and verify cleaning effectiveness using biochemical tests. As Shulimzon and Chatterji noted, cost should not overshadow the risks associated with using damaged or contaminated instruments. We agree that single-use bronchoscopes may be an option for vulnerable patients at high risk of infection. Considering these and other alternative technologies may be part of the answer, but specific evidence-based guidelines for bronchoscope reprocessing and maintenance are urgently in need of renewal. We encourage further research into the clinical effects of contaminated bronchoscope use, especially in situations involving immunocompromised patients. This information will be essential in informing best practice and could stimulate refinement of the technology used for bronchoscopy. Effectiveness of Reprocessing for Flexible Bronchoscopes and Endobronchial Ultrasound BronchoscopesCHESTVol. 154Issue 5PreviewInfections have been linked to inadequately reprocessed flexible bronchoscopes, 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. Full-Text PDF Infections and Damaged Flexible Bronchoscopes: Time for a ChangeCHESTVol. 155Issue 6PreviewWe read with interest the study on the effectiveness of bronchoscope reprocessing by Ofstead et al1 and the accompanying editorial by Mehta and Gildea2 in the November 2018 issue of CHEST. We would like to comment on two issues raised by this study. Full-Text PDF" @default.
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• W4245546486 date "2019-06-01" @default.
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• W4245546486 title "Response" @default.
• W4245546486 doi "https://doi.org/10.1016/j.chest.2019.01.023" @default.
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