With nearly 500,000 bronchoscopies performed annually in the United States, human error is unavoidable. But there are many ways a bronchoscopist or bronchoscopy team can minimize the risk of infection, including ventilator-associated pneumonia (VAP), that can be associated with bronchoscopies.
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Proper bronchoscope disinfection and handling can help keep VAP numbers low. Although reprocessing protocols can be extensive, they are a tried-and-true method to keep infection rates low. Revising disinfection protocols to keep up with current recommendations, or in response to outbreaks, can also improve outcomes.
Automated reprocessors deserve special attention. Reprocessing staff should check that machines are properly penetrating bronchoscope channels during disinfection. By checking for proper connectors and bronchoscope-reprocessor compatibility, staff can ensure automated reprocessors are operating efficiently. Reprocessors should be examined regularly for contamination. “Although the inside of the devices is periodically disinfected, water supply tanks, tubing, and pumps are not in contact with disinfectant. These areas may serve as reservoirs for contaminating pathogens,” cautions one group. Bronchoscopy teams can regularly disinfect these elements to reduce biofilm formation. With regular maintenance, automated reprocessors can ensure cleaning consistency and eliminate human errors.
Even after manual and automated cleaning, staff can take additional measures to prevent infections like VAP. Bronchoscopes exit automated reprocessors wet. They must be rinsed in non-contaminated water and hung to dry. Staff should not reassemble bronchoscopes until they are fully dry. Post-reprocessing is a prime opportunity for contamination. Hand hygiene, while often emphasized at point of care, is paramount even when transporting scopes to and from storage. The most common contaminants found on bronchoscopes in storage are skin flora species, suggesting improper handling. Even traditionally non-pathogenic bacteria put patients at risk if introduced to the respiratory tract.
Bronchoscopists can also routinely review microbiologic data looking for unexpected clusters or trends. Although costly, this is one way to check for effective bronchoscope reprocessing protocols. Hospitals should formulate surveillance plans that include which bronchoscope components to sample, and the significance of different organisms and bacterial burdens. These will vary based upon bronchoscopy volume and ICU patient population. Proper overall VAP surveillance stratified by outcome and causative organism can help identify infection control breaches. Extensive guidance is available from the Association for Professionals in Infection Control and Epidemiology, including example surveillance forms and calculators.