Hostname: page-component-5f56664f6-kch4j Total loading time: 0 Render date: 2025-05-07T06:55:19.023Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2015

Mircea Sorin ,
Sorana Segal-Maurer ,
Noriel Mariano ,
Carl Urban ,
Anna Combest  and
James J. Rahal
Mircea Sorin
Affiliation:
Department of Medicine, Division of Infectious Diseases, Division of Infection Control, the New York Hospital Medical Center of Queens, Flushing, New York
Sorana Segal-Maurer*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Division of Infection Control, the New York Hospital Medical Center of Queens, Flushing, New York
Noriel Mariano
Affiliation:
Infectious Diseases Research Laboratory, Division of Infection Control, the New York Hospital Medical Center of Queens, Flushing, New York
Carl Urban
Affiliation:
Infectious Diseases Research Laboratory, Division of Infection Control, the New York Hospital Medical Center of Queens, Flushing, New York
Anna Combest
Affiliation:
Department of Nursing, Division of Infection Control, the New York Hospital Medical Center of Queens, Flushing, New York
James J. Rahal
Affiliation:
Department of Medicine, Division of Infectious Diseases, Division of Infection Control, the New York Hospital Medical Center of Queens, Flushing, New York
*
The New York Hospital Medical Center of Queens, Division of Infectious Diseases, 56-45 Main St, Flushing, NY 11355
Get access Rights & Permissions [Opens in a new window]

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 7 , July 2001 , pp. 409 - 413
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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.)

Article purchase

Temporarily unavailable

References

1.Favero, MS. Strategies for disinfection and sterilization of endoscopes: the gap between basic principles and actual practice. Infect Control Hosp Epidemiol 1991;12:279–281.CrossRefGoogle Scholar
2.Reichert, M. Automatic washers/disinfectors for flexible endoscopes. Infect Control Hosp Epidemiol 1991;12:497–499.CrossRefGoogle ScholarPubMed
3.Crow, S. Peracetic acid sterilization: a timely development for a busy healthcare industry. Infect Control Hosp Epidemiol 1992;13:111–113.CrossRefGoogle ScholarPubMed
4.Wallace, CG, Agee, PM, Demicco, DD. Liquid chemical sterilization using peracetic acid: an alternative approach to endoscope processing. ASAIO Journal 1995;41:151–154.Google Scholar
5.Muscarella, LF. High-level disinfection or “sterilization” of endoscopes? Infect Control Hosp Epidemiol 1996;17:183–187.Google ScholarPubMed
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;26:393–398.CrossRefGoogle ScholarPubMed
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;26:469–477.CrossRefGoogle ScholarPubMed
8.Rutala, WA, Weber, DJ. Clinical effectiveness of low-temperature sterilization technologies. Infect Control Hosp Epidemiol 1998;19:798–804.CrossRefGoogle ScholarPubMed
9.Rutala, WA, Weber, DJ. Disinfection of endoscopes: review of new chemical sterilants used for high-level disinfection. Infect Control Hosp Epidemiol 1999;20:69–76.CrossRefGoogle ScholarPubMed
10.Reducing endoscopic contamination levels: are liquid disinfecting and sterilizing reprocessors the solution? Health Devices 1994;23:212–253.Google Scholar
11.Bradley, CR, Babb, JR, Ayliffe, GAJ. Evaluation of the STERIS System 1 peracetic acid endoscope processor. J Hosp Infect 1995;29:143–151.Google Scholar
12.Webb, SF, Val-Spinosa, A. Outbreak of Serratia marcescens associated with the flexible fiberbronchoscope. Chest 1975;68:703–708.Google Scholar
13.Sammartino, MT, Israel, RH, Magnussen, CR. Pseudomonas aeruginosa contamination of fibreoptic bronchoscopes. J Hosp Infect 1982;3:65–71.Google Scholar
14.Goldstein, B, Abrutyn, E. Pseudo-outbreak of Bacillus species: related to fibreoptic bronchoscopy. J Hosp Infect 1985;6:194–200.CrossRefGoogle ScholarPubMed
15.Centers for Disease Control and Prevention. Nosocomial infection and pseudoinfection from contaminated endoscopes and bronchoscopes—Wisconsin and Missouri. MMWR 1991;40:675–678.Google Scholar
16.Whitlock, WL, Dietrich, RA, Steimke, EH, Tenholder, MF. Rhodotorula rubra contamination in fiberoptic bronchoscopy. Chest 1992;102:1516–1519.Google Scholar
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;145:853–855.CrossRefGoogle Scholar
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;23:263–270.Google Scholar
19.Spach, DH, Silverstein, FE, Stamm, WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117–128.CrossRefGoogle ScholarPubMed
20.Bryce, EA, Walker, M, Bevan, C, Smith, JA. Contamination of bronchoscopes with Mycobacterium tuberculosis. Can J Infect Control 1993;8:35–36.Google ScholarPubMed
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;26:653–657.Google Scholar
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;169:1166–1169.Google Scholar
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;89:423–427.Google Scholar
24.Reeves, DS, Brown, NM. Mycobacterial contamination of fibreoptic bronchoscopes. J Hosp Infect 1995;30(suppl):S531–S536.Google Scholar
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;16:727–728.CrossRefGoogle Scholar
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;37:19–23.Google Scholar
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;278:1073–1077.Google Scholar
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.Google Scholar
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):272S–280S.Google Scholar
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;18:134–136.Google Scholar
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.Google Scholar
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.Google Scholar
33.Centers for Disease Control and Prevention. Bronchoscopy-related infections and pseudo-infections—New York, 1996 and 1998. MMWR 1999;48:557–560.Google Scholar
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;50:152–158.CrossRefGoogle ScholarPubMed
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;7.1:563–572.Google Scholar
36.Harvey, J, Yates, M. Do you clean or contaminate your bronchoscope? Respir Med 1996;90:63–67.Google Scholar
37.McDonnell, G, Russell, AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999;12:147–179.Google Scholar
38.Fraise, AP. Disinfection in endoscopy. Lancet 1995;34:787–788.CrossRefGoogle Scholar
39.Rutala, WA, Weber, DJ. Low-temperature sterilization technologies: do we need to redefine “sterilization”? Infect Control Hosp Epidemiol 1996;17:87–91.CrossRefGoogle ScholarPubMed
40.Jackson, J, Leggett, JE, Wilson, D, Gilbert, DN. Mycobacteria gordonae in fibreoptic bronchoscopes. Am J Infect Control 1996;24:19–23.Google Scholar
41.Mannion, PT. The use of peracetic acid for the reprocessing of flexible endoscopes and rigid cystoscopes and laparoscopes. J Hosp Infect 1995;29:313–315.Google Scholar
42.Alfa, MJ. Importance of lumen flow in liquid chemical sterilization. Am J Infect Control 1999;27:373–374.CrossRefGoogle ScholarPubMed
43.Rutala, WJ, Gergen, MF, Weber, D. Reply. Am J Inject Control 1999;27:374–375.Google Scholar
44.Bond, WW. Biological indicators for a liquid chemical sterilizer: a solution to the instrument reprocessing problem? Infect Control Hosp Epidemiol 1993;4:309–312.Google Scholar
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.Google Scholar