Skip to main content Accessibility help
×
Home

Pseudo-Outbreak of Mycobacterium chelonae and Methtlobactertum mesophilicum Caused by Contamination of an Automated Endoscopy Washer

  • Amy Beth Kressel (a1) and Francine Kidd (a2)

Abstract

Objective:

To evaluate an unusual number of rapidly growing acid-fast bacilli, later identified as Mycobacterium chelonae, and pink bacteria, later identified as Methylo-bacterium mesophilicum, from fungal cultures obtained by bronchoscopy.

Design:

Outbreak investigation.

Setting:

An academic medical center performing approximately 500 bronchoscopies and 4,000 gastrointestinal endoscopies in 1998.

Patients:

Patients undergoing bronchoscopy July 21 to October 2, 1998.

Methods:

The infection control department reviewed patient charts and bronchoscopy logs; obtained cultures of source water, faucets, washers, unopened glutaraldehyde, glutaraldehyde from the washers, and endoscopes; observed endoscope and bronchoscope cleaning and disinfecting procedures; reviewed glutaraldehyde monitoring records; and sent M chelonae isolates for DNA fingerprinting.

Results:

M chelonae, M mesophilicum, gram-negative bacteria, and various molds grew from endoscopes, automated washers, and glutaraldehyde from the washers but not from unopened glutaraldehyde. The endoscopy unit regularly monitored the pH of glutaraldehyde, and the logs contained no deficiencies. The above sources remained positive for the same organisms after a glutaraldehyde cleaning cycle of the automated washers. DNA fingerprinting of the M chelonae revealed that they were clonally related.

Conclusions:

The automated washers were contaminated with a biofilm that rendered them resistant to decontamination. The washers then contaminated the endoscopes and bronchoscopes they were used to disinfect. Our institution purchased new endoscopes and a new paracetic acid sterilization system.

Copyright

Corresponding author

University of Cincinnati, PO Box 670560, Cincinnati, OH, 45267-0560

References

Hide All
1.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.
2.Fraser, VJ, Jones, M, Murray, PR, Medoff, G, Zhang, Y, Wallace, J, et al.Contamination of flexible fiberoptic bronchoscopes with Mycobacterium chelonae linked to an automated bronchoscope disinfection machine. Am Rev RespirDis 1992;145:853855.
3.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.
4.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.
5.Fraser, VJ, Zuckerman, G, Clouse, RE, O'Rourke, S, Jones, M, Klasner, J, et al.A prospective randomized trial comparing manual and automated endoscope disinfection methods. Infect Control Hosp Epidemiol 1993;14:383389.
6.Kovacs, BJ, Chen, YK, Kettering, JD, Aprecio, RM, Roy, I. High-level disinfection of gastrointestinal endoscopes: are current guidelines adequate? Am J Gastroenterol 1999;94:15461550.
7.Ascenzi, JM, Ezzell, RJ, Wendt, TM. More accurate method for measurement of tuberculocidal activity of disinfectants. Appl Environ Microbiol 1987;53:21892192.
8.Martin, MA, Reichelderfer, M. APIC guideline for infection prevention and control in flexible endoscopy. Am J Infect Control 1994;22:1938.
9.Deva, AK, Vickery, K, Zou, J, West, RH, Selby, W, Benn, RAV, et al.Detection of persistent vegetative bacteria and amplified viral nucleic acid from in-use testing of gastrointestinal endoscopes. J Hosp Infect 1998;39:149157.
10.Spach, DH, Silverstein, FE, Stamm, WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117128.
11.Bronowicki, J-P, Venard, V, Botte, C, Monhoven, N, Gastin, I, Chone, L, et al.Patient-to-patient transmission of hepatitis C virus during colonoscopy. N Engl J Med 1997;337:237240.
12.Agerton, T, Valway, S, Gore, B, Pozsik, C, Plikaytis, B, Woodley, C, et al.Transmission of a highly drug-resistant strain (strain W1) of Mycobacterium tuberculosis: community outbreak and nosocomial transmission via a contaminated bronchoscope. JAMA 1997;278:10731077.
13.Centers for Disease Control and Prevention. Bronchoscopy-related infections and pseudoinfections—New York, 1996 and 1998. MMWR 1999;48:557560.

Metrics

Altmetric attention score

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