Bronchoscopes and Contamination
by Ashley Small
Endoscopes have been in the news for many years as contamination concerns have been brought to light. Unfortunately, these issues do not typically get attention until there is a large adverse event that causes the topic to appear in the news. Supporting the risk of this contamination, ECRI consistently includes cleaning and decontamination in their yearly top ten list of patient safety concerns.
Cori Ofstead recently presented a webinar (available on her website) where she discussed COVID-19 and its effect on endoscopes, and specifically bronchoscopes. She discussed how after following some developments of respiratory illnesses in Wuhan, China, she found it very interesting that pathogens that were not typically found in bronchoscopes were discovered in BAL samples (sterile water is sent down the bronchoscope into the lungs and then suctioned back out).
In an article from Healio, Ofstead stated, “the lab results caught my eye because samples from patients’ lungs contained the COVID-19 virus, as well as fungi, waterborne pathogens and bacteria generally found in the gastrointestinal system. Those germs should not be there.”2 This would indicate there must be cross-contamination between endoscopes used in the gastrointestinal tract or contaminated in some other way. This could happen in the manual cleaning area if reusable products are used and not reprocessed correctly or if the area itself is not decontaminated between scopes. In addition, there could be a problem within the AER causing this contamination or dirty filters.
Another study by Ofstead and her team tested 24 clinically used endoscopes. All of the endoscopes had residual contamination and irregularities after manual cleaning3. If the guidelines are not followed correctly and the manual cleaning steps are not completed adequately, patients are in danger of cross-contamination and possible infections.
Since COVID-19 is an upper respiratory track illness, bronchoscopes may be required for use on patients. If these other pathogens are transferred to patients, because of inadequately reprocessed bronchoscopes, they may cause an increased risk of more negative health outcomes. COVID-10 should not be the only reason to more thoroughly manual clean and reprocess scopes, but with what we have learned from the cases in China, we see that these pathogens found in bronchoscopes, may result in a greater risk to patients who acquire the coronavirus.
There can be more than one size of channel within bronchoscopes. Be cognizant of this when choosing brushes to manually clean the channels of a bronchoscope. Manual cleaning is the most important part of reprocessing, even without examples of contamination making it into news articles.
Visit the Ofstead & Associates website to sign up for an account and watch educational webinars. https://ofsteadinsights.com/webinars