Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-05-31T13:58:35.321Z Has data issue: false hasContentIssue false
  • English
  • Français

Potential Nosocomial Exposure to Mycobacterium tuberculosis From a Bronchoscope

Published online by Cambridge University Press:  02 January 2015

Janet L. Larson ,
Lauren Lambert ,
Rachel L. Stricof ,
Jeffrey Driscoll ,
Michael A. McGarry  and
Renée Ridzon
Janet L. Larson
Affiliation:
Surveillance and Epidemiology Branch, Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Lauren Lambert
Affiliation:
Surveillance and Epidemiology Branch, Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Rachel L. Stricof
Affiliation:
Bureau of Tuberculosis Control, New York
Jeffrey Driscoll
Affiliation:
Wadsworth Center, New York State Department of Health, Albany, New York
Michael A. McGarry
Affiliation:
Wadsworth Center, New York State Department of Health, Albany, New York
Renée Ridzon*
Affiliation:
Surveillance and Epidemiology Branch, Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Bill and Melinda Gates Foundation, PO Box 23350, Seattle, WA 98102
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate a possible nosocomial outbreak of tuberculosis (TB).

Design:

Retrospective cohort study.

Setting:

Community hospital.

Methods:

We reviewed medical records, hospital infection control measures, and potential locations of nosocomial exposure. We examined the results of acid-fast bacilli (AFB) smears, cultures, and drug susceptibility testing, and performed a DNA fingerprint analysis. We observed laboratory specimen processing procedures and bronchoscope disinfection procedures. We also reviewed bronchoscopy records.

Results:

In October 2000, three patients had bronchoscopy specimen cultures that were positive for Mycobacterium tuberculosis. Of the three, only one had clinical signs and symptoms consistent with TB and positive AFB sputum smears. The other two did not have signs and symptoms consistent with TB and had no known exposure to individuals with infectious TB. The three M. tuberculosis isolates had matching DNA fingerprints. No evidence of laboratory cross-contamination was identified. The three culture-positive specimens of M. tuberculosis were collected with the same bronchoscope within 9 days. This bronchoscope was inadequately cleaned and disinfected between patients, and the automated reprocessor used was not approved for use with the hospital bronchoscope.

Conclusions:

One of the bronchoscopes at this hospital was contaminated with M. tuberculosis during bronchoscopy of an AFB-smear-positive patient. Subsequent specimen contamination likely occurred because the bronchoscope had been inadequately cleaned and disinfected. Patients who subsequently underwent bronchoscopy were also potentially exposed to M. tuberculosis from this bronchoscope.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 11 , November 2003 , pp. 825 - 830
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Centers for Disease Control and Prevention. Reported Tuberculosis in the United States, 2000. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2001. Available at www.cdc.gov/nchstp/tb/.Google Scholar
2. Institute of Medicine. Ending Neglect: The Elimination of Tuberculosis in the United States. Washington, DC: National Academy Press; 2000:89.Google Scholar
3. Ehrenkranz, NJ, Kicklighter, JL. Tuberculosis outbreak in a general hospital: evidence of airborne spread of infection. Ann Intern Med 1972;77:377–382.Google Scholar
4. Hutton, MD, Stead, WW, Cauthen, GM, et al. Nosocomial transmission of tuberculosis associated with a draining tuberculous abscess. J Infect Dis 1990;161:286–295.Google Scholar
5. D'Agata, EM, Wise, S, Stewart, A, Lefkowitz, LB. Nosocomial transmission of Mycobacterium tuberculosis from an extrapulmonary site. Infect Control Hosp Epidemiol 2001;22:10–12.CrossRefGoogle ScholarPubMed
6. Collins, CH, Grange, JM. Tuberculosis acquired in laboratories and necropsy rooms. Commun Dis Public Health 1999;2:161–167.Google ScholarPubMed
7. Wheeler, PW, Lancaster, D, Kaiser, AB. Bronchopulmonary cross-colonization and infection related to mycobacterial contamination of suction valves of bronchoscopes. J Infect Dis 1989;159:954–958.Google Scholar
8. Agerton, T, Valway, S, Gore, B, et al. Transmission of a highly drug-resistant strain (strain Wl) of Mycobacterium tuberculosis . JAMA 1997;278:1073–1077.Google Scholar
9. Michele, TM, Cronin, WA, Graham, NM, et al. Transmission of Mycobacterium tuberculosis by a fiberoptic bronchoscope: identification by DNA fingerprinting. JAMA 1997;278:1093–1095.Google Scholar
10. Centers for Disease Control and Prevention. Bronchoscopy-related infections and pseudoinfections: New York, 1996 and 1998. MMWR 1999;48:557–560.Google Scholar
11. Kamerbeek, J, Schouls, L, Kolk, A et al. Simultaneous detection and strain differentiation of Mycobacterium tuberculosis for diagnosis and epidemiology. J Clin Microbiol 1997;35:907–914.Google Scholar
12. Van Embden, JDA, Cave, MD, Crawford, JT, et al. Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol 1993;31:406–409.Google Scholar
13. Alvarado, CJ, Reichelderfer, M. APIC guideline for infection prevention and control in flexible endoscopy. Am J Infect Control 2000;28:138–155.Google Scholar
14. Nicholson, G, Hudson, RA, Chadwick, MV, et al. The efficacy of the disinfection of bronchoscopes contaminated in vitro with Mycobacterium tuberculosis and Mycobacterium awam-intracellulare in sputum: a comparison of I-Sinald and glutaraldehyde. J Hosp Infect 1995;29:257–264.CrossRefGoogle ScholarPubMed
15. American Thoracic Society, Centers for Disease Control and Prevention. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000;161:1376–1395.CrossRefGoogle Scholar
16. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994. MMWR 1994;43(RR-13):1–132.Google Scholar
17. U.S. Food and Drug Administration, Center for Devices and Radiological Health. FDA and CDC Public Health Advisory: Infections From Endoscopes Inadequately Reprocessed by an Automated Endoscope Reprocessing System. Washington, DC: U.S. Food and Drug Administration, Center for Devices and Radiological Health; 1999:1–4. Available at www.fda.gov/cdrh/safety/endoreprocess.html.Google Scholar
18. Rutala, WA. APIC guideline for selection and use of disinfectants. Am J Infect Control 1996;24:313–342.Google Scholar
19. Bennett, SN, Peterson, DE, Johnson, DR, et al. Bronchoscopy-associat-ed Mycobacterium xenopi pseudoinfections. Am J Respir Crit Care Med 1994;150:245–250.Google Scholar
20. Maloney, S, Welbel, S, Daves, B, et al. Mycobacterium abscessus pseudoinfection traced to an automated endoscope washer: utility of epidemiologic and laboratory investigation. J Infect Dis 1994;169:1166–1169.Google Scholar
21. Gubler, JG, Salfinger, M, von Graevenitz, A. Pseudoepidemic of nontuberculous mycobacteria due to a contaminated bronchoscope cleaning machine: report of an outbreak and review of the literature. Chest 1992;101:1245–1249.Google Scholar
22. Fraser, VJ, Jones, M, Murray, PR, et al. Contamination of flexible fiberoptic bronchoscopes with Mycobacterium chelonae linked to an automated bronchoscope disinfection machine. Am Rev Respir Dis 1992;145:853–855.Google Scholar
23. Center for Disease Control. Nosocomial infection and pseudoinfection from contaminated endoscopes and bronchoscopes: Wisconsin and Missouri. MMWR 1991;40:675–678.Google Scholar
24. Kaczmarek, RG, Moore, RM, McCrohan, J, et al. Multi-state investigation of the actual disinfection/sterilization of endoscopes in health care facilities. Am J Med 1992;92:257–261.Google Scholar