Effectiveness of Reprocessing for Flexible Bronchoscopes and Endobronchial Ultrasound Bronchoscopes


      Infections have been linked to inadequately reprocessed flexible bronchoscopes, and recent investigations determined that pathogen transmission occurred even when bronchoscope cleaning and disinfection practices aligned with current guidelines. This multisite, prospective study evaluated the effectiveness of real-world bronchoscope reprocessing methods, using a systematic approach.


      This study involved direct observation of reprocessing methods for flexible bronchoscopes, multifaceted evaluations performed after manual cleaning and after high-level disinfection, and assessments of storage conditions. Visual inspections of ports and channels were performed using lighted magnification and borescopes. Contamination was detected using microbial cultures and tests for protein, hemoglobin, and adenosine triphosphate (ATP). Researchers assessed reprocessing practices, and storage cabinet cleanliness was evaluated by visual inspection and ATP tests.


      Researchers examined 24 clinically used bronchoscopes. After manual cleaning, 100% of bronchoscopes had residual contamination. Microbial growth was found in 14 fully reprocessed bronchoscopes (58%), including mold, Stenotrophomonas maltophilia, and Escherichia coli/Shigella species. Visible irregularities were observed in 100% of bronchoscopes, including retained fluid; brown, red, or oily residue; scratches; damaged insertion tubes and distal ends; and filamentous debris in channels. Reprocessing practices were substandard at two of three sites.


      Damaged and contaminated bronchoscopes were in use at all sites. Inadequate reprocessing practices may have contributed to bioburden found on bronchoscopes. However, even when guidelines were followed, high-level disinfection was not effective. A shift toward the use of sterilized bronchoscopes is recommended. In the meantime, quality management programs and updated reprocessing guidelines are needed.

      Key Words


      AER ( automated endoscope reprocessor), ATP ( adenosine triphosphate), CFU ( colony-forming unit), EBUS ( endobronchial ultrasound), FDA ( Food and Drug Administration), HLD ( high-level disinfection), PPE ( personal protective equipment), RLU ( relative light units)
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      Linked Article

      • Infections and Damaged Flexible Bronchoscopes
        CHESTVol. 155Issue 6
        • In Brief
          We read with interest the study on the effectiveness of bronchoscope reprocessing by Ofstead et al1 and the accompanying editorial by Mehta and Gildea2 in the November 2018 issue of CHEST. We would like to comment on two issues raised by this study.
        • Full-Text
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      • Response
        CHESTVol. 155Issue 6
        • In Brief
          We appreciate Drs Shulimzon and Chatterji’s concerns related to cross-contamination during flexible bronchoscopy (FB).1 Despite monumental advancement in the technology, little attention has been paid to this potentially serious complication of FB.2 In our opinion ignorance and circumvention are both equally responsible for the phenomenon. The former is strictly related to our reactionary enthusiasm to adopt advanced technology while detouring the fundamentals of bronchoscopy. Fellowship programs, manufacturers, and the wardens of infection prevention have collectively fallen short in educating bronchoscopists in relation to the risk of infection spread during the procedure.
        • Full-Text
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      • Response
        CHESTVol. 155Issue 6
        • In Brief
          We found the comments by Shulimzon and Chatterji insightful, and we agree that the presence of Stenotrophomonas maltophilia, Escherichia coli, and mold in patient-ready bronchoscopes in our study1 is particularly worrisome. The failure of reprocessing to completely remove exogenous contaminants is concerning, especially considering pathogens were detected in bronchoscopes even after reprocessing using superior techniques. Although Pseudomonas aeruginosa was detected in four bronchoscopes after manual cleaning, this pathogen was not found after high-level disinfection.
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