Skip to main content Accessibility help
×
Home

Nosocomial Transmission of Imipenem-Resistant Pseudomonas Aeruginosa Following Bronchoscopy Associated With Improper Connection to the STERIS SYSTEM 1 Processor

  • Mircea Sorin (a1), Sorana Segal-Maurer (a1), Noriel Mariano (a2), Carl Urban (a2), Anna Combest (a3) and James J. Rahal (a1)...

Abstract

Objective:

To assess nosocomial transmission of imipenem-resistant Pseudomonas aeruginosa (IRPA) following bronchoscopy during August through October 1998.

Design:

Traditional and molecular epidemiological investigation of a case series.

Setting:

University-affiliated community hospital.

Patients:

18 patients with IRPA bronchial-wash isolates.

Interventions:

We reviewed clinical data, performed environmental cultures and molecular analysis of all IRPA isolates, and observed disinfection of bronchoscopes.

Results:

Of 18 patients who had IRPA isolated from bronchoscopic or postbronchoscopic specimens, 13 underwent bronchoscopy for possible malignancy or undiagnosed pulmonary infiltrates. Following bronchoscopy, 3 patients continued to have IRPA isolated from sputum and demonstrated clinical evidence of infection requiring specific antimicrobial therapy. The remaining 15 patients had no further IRPA isolated and remained clinically well 3 months following bronchoscopy. Pulsed-field gel electrophoresis revealed that all strains except one were >95% related. STERIS SYSTEM 1 had been implemented in July 1998 as an automatic endoscope reprocessor (AER) for all endoscopes and bronchoscopes. Inspection of bronchoscope sterilization cycles revealed incorrect connectors joining the bronchoscope suction channel to the STERIS SYSTEM 1 processor, obstructing peracetic acid flow through the bronchoscope lumen. No malfunction warning was received, and spore strips remained negative.

Conclusions:

The similarity of diverse connectors and limited training by the manufacturer regarding AER for bronchoscopes were the two factors responsible for the outbreak. Appropriate connections were implemented, and there was no further bronchoscope contamination. We suggest active surveillance of all bronchoscopy specimen cultures, standardization of connectors of various scopes and automated processors, and systematic education of staff by manufacturers with periodic on-site observation.

Copyright

Corresponding author

The New York Hospital Medical Center of Queens, Division of Infectious Diseases, 56-45 Main St, Flushing, NY 11355

References

Hide All
1.Favero, MS. Strategies for disinfection and sterilization of endoscopes: the gap between basic principles and actual practice. Infect Control Hosp Epidemiol 1991;12:279281.
2.Reichert, M. Automatic washers/disinfectors for flexible endoscopes. Infect Control Hosp Epidemiol 1991;12:497499.
3.Crow, S. Peracetic acid sterilization: a timely development for a busy healthcare industry. Infect Control Hosp Epidemiol 1992;13:111113.
4.Wallace, CG, Agee, PM, Demicco, DD. Liquid chemical sterilization using peracetic acid: an alternative approach to endoscope processing. ASAIO Journal 1995;41:151154.
5.Muscarella, LF. High-level disinfection or “sterilization” of endoscopes? Infect Control Hosp Epidemiol 1996;17:183187.
6.Rutala, WA, Gergen, MF, Weber, DJ. Comparative evaluation of the sporicidal activity of new low-temperature sterilization technologies: ethylene oxide, 2 plasma sterilization systems, and liquid peracetic acid. Am J Infect Control 1998;26:393398.
7.Alfa, MJ, Degagne, P, Olson, N, Hizon, R. Comparison of liquid chemical sterilization with peracetic acid and ethylene oxide sterilization for long narrow lumens. Am J Infect Control 1998;26:469477.
8.Rutala, WA, Weber, DJ. Clinical effectiveness of low-temperature sterilization technologies. Infect Control Hosp Epidemiol 1998;19:798804.
9.Rutala, WA, Weber, DJ. Disinfection of endoscopes: review of new chemical sterilants used for high-level disinfection. Infect Control Hosp Epidemiol 1999;20:6976.
10.Reducing endoscopic contamination levels: are liquid disinfecting and sterilizing reprocessors the solution? Health Devices 1994;23:212253.
11.Bradley, CR, Babb, JR, Ayliffe, GAJ. Evaluation of the STERIS System 1 peracetic acid endoscope processor. J Hosp Infect 1995;29:143151.
12.Webb, SF, Val-Spinosa, A. Outbreak of Serratia marcescens associated with the flexible fiberbronchoscope. Chest 1975;68:703708.
13.Sammartino, MT, Israel, RH, Magnussen, CR. Pseudomonas aeruginosa contamination of fibreoptic bronchoscopes. J Hosp Infect 1982;3:6571.
14.Goldstein, B, Abrutyn, E. Pseudo-outbreak of Bacillus species: related to fibreoptic bronchoscopy. J Hosp Infect 1985;6:194200.
15.Centers for Disease Control and Prevention. Nosocomial infection and pseudoinfection from contaminated endoscopes and bronchoscopes—Wisconsin and Missouri. MMWR 1991;40:675678.
16.Whitlock, WL, Dietrich, RA, Steimke, EH, Tenholder, MF. Rhodotorula rubra contamination in fiberoptic bronchoscopy. Chest 1992;102:15161519.
17.Fraser, VJ, Jones, M, Murray, PR, Medoff, G, Zhang, Y, Wallace, RJ Jr. Contamination of flexible fibreoptic bronchoscopes with Mycobacterium chelonae linked to an automated bronchoscope disinfecting machine. Am Rev RespirDis 1992;145:853855.
18.Vandenbroucke-Grauls, CM, Baars, AC, Visser, MR, Hulstaert, PF, Verhoef, J. An outbreak of Serratia marcescens traced to a contaminated bronchoscope. J Hosp Infect 1993;23:263270.
19.Spach, DH, Silverstein, FE, Stamm, WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117128.
20.Bryce, EA, Walker, M, Bevan, C, Smith, JA. Contamination of bronchoscopes with Mycobacterium tuberculosis. Can J Infect Control 1993;8:3536.
21.Kolmos, HJ, Lerche, A, Kristoffersen, K, Rosdahl, VT. Pseudo-outbreak of Pseudomonas aeruginosa in HIV-infected patients undergoing fiberoptic bronchoscopy. Scand J Infect Dis 1994;26:653657.
22.Maloney, S, Welbel, S, Daves, B, Adams, K, Becker, S, Bland, L, et al.Mycobacterium abscessus pseudoinfection traced to an automated endoscope washer: utility of epidemiologic and laboratory investigation. J Infect Dis 1994;169:11661169.
23.Takigawa, K, Fujita, J, Negayama, K, Terada, S, Yamaji, S, Kawanashi, K, et al.Eradication of contaminating Mycobacterium chelonae from bron-chofibrescopes and an automated bronchoscope disinfection machine. RespirMed 1995;89:423427.
24.Reeves, DS, Brown, NM. Mycobacterial contamination of fibreoptic bronchoscopes. J Hosp Infect 1995;30(suppl):S531S536.
25.Hagan, ME, Klotz, SA, Bartholomew, W, Potter, L, Nelson, M. A pseudo-epidemic of Rhodotorula rubra: a marker for microbial contamination of the bronchoscope. Infect Control Hosp Epidemiol 1995;16:727728.
26.Mitchell, DH, Hicks, LJ, Chiew, R, Montanaro, JC, Chen, SC. Pseudoepidemic of Legionella pneumophila serogroup 6 associated with contaminated bronchoscopes. J Hosp Infect 1997;37:1923.
27.Agerton, T, Valway, S, Gore, B, Pozsik, C, Plikaytis, B, Woodley, C, et al.Transmission of a highly drug-resistant strain of Mycobacterium tuberculosis: community outbreak and nosocomial transmission via a contaminated bronchoscope. JAMA 1997;278:10731077.
28.Bond, M, Huver, B, Alexander, D. Mycobacterium tuberculosis contamination of a bronchoscope. Presented at the 27th Annual Meeting of the American Practitioners in Infection Control; June 20-24, 1999; Baltimore, MD. P 220.
29.Alvarado, CJ, Stolz, SM, Maki, DG. Nosocomial infections from contaminated endoscopes: a flawed automated endoscope washer. An investigation using molecular epidemiology. Am J Med 1991;91(suppl 3B):272S280S.
30.Blanc, DS, Parret, T, Janin, B, Raselli, P, Francioli, P. Nosocomial infections and pseudoinfections from contaminated bronchoscopes: two-year follow-up using molecular markers. Infect Control Hosp Epidemiol 1997;18:134136.
31.Strelczyk, K. Pseudo-outbreak of acid-fast bacilli. Presented at the 27th Annual Meeting of the American Practitioners in Infection Control; June 20-24, 1999; Baltimore, MD. P 198.
32.Curchoe, R, Scott, A. Investigating a pseudo-outbreak of Mycobacterium fortuitum. Presented at the 27th Annual Meeting of the American Practitioners in Infection Control; June 20-24, 1999; Baltimore, MD. P 197.
33.Centers for Disease Control and Prevention. Bronchoscopy-related infections and pseudo-infections—New York, 1996 and 1998. MMWR 1999;48:557560.
34.Cronmiller, JR, Nelson, DK, Salman, G, Jackson, DK, Dean, RS, Hsu, JJ, et al.Antimicrobial efficacy of endoscopic disinfection procedures: a controlled, multifactorial investigation. Gastrointest Endosc 1999;50:152158.
35.Maslow, JN, Slutsky, AM, Arbeit, RD. Application of pulsed-field gel electrophoresis to molecular epidemiology. In: Persing, DH, Smith, TF, Tenover, FC, White, TJ, eds. Diagnostic Molecular Microbiology: Principles and Applications. Washington, DC: American Society for Microbiology; 1993;7.1:563572.
36.Harvey, J, Yates, M. Do you clean or contaminate your bronchoscope? Respir Med 1996;90:6367.
37.McDonnell, G, Russell, AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999;12:147179.
38.Fraise, AP. Disinfection in endoscopy. Lancet 1995;34:787788.
39.Rutala, WA, Weber, DJ. Low-temperature sterilization technologies: do we need to redefine “sterilization”? Infect Control Hosp Epidemiol 1996;17:8791.
40.Jackson, J, Leggett, JE, Wilson, D, Gilbert, DN. Mycobacteria gordonae in fibreoptic bronchoscopes. Am J Infect Control 1996;24:1923.
41.Mannion, PT. The use of peracetic acid for the reprocessing of flexible endoscopes and rigid cystoscopes and laparoscopes. J Hosp Infect 1995;29:313315.
42.Alfa, MJ. Importance of lumen flow in liquid chemical sterilization. Am J Infect Control 1999;27:373374.
43.Rutala, WJ, Gergen, MF, Weber, D. Reply. Am J Inject Control 1999;27:374375.
44.Bond, WW. Biological indicators for a liquid chemical sterilizer: a solution to the instrument reprocessing problem? Infect Control Hosp Epidemiol 1993;4:309312.
45.Feigal, DW Jr, Hughes, JM. Infections from endoscopes inadequately reprocessed by an automated endoscope reprocessing system. FDA and CDC Public Health Advisory, DHHS, September 10, 1999. www.fda.gov/cdrh/safety/endoreprocess.pdf.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed