Table 5

Infections associated with flexible bronchoscopy

ReferenceMicroorganism(s)No. of contaminated patients after endoscopyNo. of infected patientsInfection(s)Detection of endoscope contaminationCause(s) of contamination a
73 P. aeruginosa 111PneumoniaYesInappropriate cleaning and disinfection (povidone-iodine); drying with no ethanol flushing
70 P. aeruginosa 80NoYesLack of manual cleaning; drying with no ethanol flushing
102 P. aeruginosa 35No dataNo dataYesContaminated AER
104 P. aeruginosa 183PneumoniaNo dataInadequate cleaning and disinfection (incorrect connectors)
26 P. aeruginosa 88Sepsis, pneumoniaYesContaminated AER (biofilm on internal plumbing); no protocol for manual cleaning; lack of drying procedure
103 P. aeruginosa 183PneumoniaYesContaminated AER; incorrect AER connectors (obstruction of disinfectant flow)
107 P. aeruginosa, S. marcescens 20 (P. aeruginosa), 6 (S. marcescens)1PneumoniaYesLoose biopsy port cap of the contaminated bronchoscopes
30 P. aeruginosa, S. marcescens 410NoYesInsufficient disinfectant exposure; rinsing with tap water; drying with no ethanol flushing
93 P. aeruginosa 3232Pneumonia, bacteremia/sepsis, bronchitis, sinusitisYesLoose biopsy port cap of the contaminated bronchoscopes
105 P. aeruginosa 164PneumoniaYesDefective biopsy forceps and damaged endoscope channel
64 P. aeruginosa 107Pneumonia, bronchitisNot testedInappropriate disinfection (povidone-iodine); lack of drying procedure
74 P. aeruginosa 77Pneumonia, bronchitisYesContaminated AER (detergent tank); inadequate manual cleaning; drying with no ethanol flushing
106 P. aeruginosa 1212Pneumonia, sepsisYesMultiple manufacturing defects of the contaminated bronchoscope
27 M. tuberculosis 10NoNo dataInappropriate disinfection (iodophor solution); lack of manual cleaning; drying procedure not described
109 M. tuberculosis 21Lung tuberculosisYesInappropriate disinfection (iodophor solution)
111 M. tuberculosis 31Lung tuberculosisYesContaminated suction valves (failure to disinfect with glutaraldehyde)
63 M. tuberculosis 31Multidrug-resistant lung tuberculosisYesInadequate cleaning and disinfection (no immersion in disinfectant); drying with no ethanol flushing
66 M. tuberculosis 10NoNo dataInappropriate cleaning and disinfection; lack of drying procedure
108 M. tuberculosis 11Lung tuberculosisNo dataInappropriate cleaning and disinfection; drying procedure not described
125 M. tuberculosis 80NoYesContaminated automated aspiration adaptor (no manual cleaning and disinfection)
104 M. tuberculosis 40NoNoInadequate cleaning and disinfection (biopsy port cap was not replaced before loading into the AER)
110 M. tuberculosis 93Lung tuberculosisNoHole in the sheath of the bronchoscope (no leak testing performed)
120 M. tuberculosis 20NoNoInadequate cleaning and disinfection between uses in patients (incompatibility of the bronchoscope and AER)
67 M. chelonae 70NoNoContaminated AER; drying with no ethanol flushing
124 M. chelonae 722No dataYesContaminated suction channel (punctured channel)
71 M. chelonae 70NoYesRinsing with contaminated tap water; drying with no ethanol flushing
126 M. chelonae 40NoYesContaminated suction channel valve; inadequate endoscope reprocessing
52 M. chelonae 140NoNo dataContaminated AER; inappropriate disinfection; rinsing with tap water; lack of drying procedure
24 M. chelonae 140NoNo dataContaminated AER; inappropriate cleaning and disinfection; drying with no ethanol flushing
68 M. chelonae, M. gordonae 140NoNo dataContaminated AER (rinse water tank); drying with no ethanol flushing
122 M. chelonae 120NoYesContaminated AER; inadequate endoscope reprocessing
123 M. chelonae 130NoNo dataContaminated AER; inadequate endoscope reprocessing
76 M. chelonae 150NoYesContaminated AER; inappropriate disinfection; drying with no ethanol flushing
127 M. chelonae 180NoYesContaminated suction channels; inappropriate disinfection and drying
25 M. chelonae, Methylobacterium mesophilicum 200NoYesContaminated AER (presence of biofilm)
111 M. avium complex20NoYesContaminated suction valve (failure to disinfect with glutaraldehyde)
104 M. avium complex70NoNoInadequate cleaning and disinfection (incorrect connectors)
56 M. xenopi 20NoNo dataRinsing with contaminated tap water
51 M. xenopi 203Pulmonary infection, abscessYesRinsing with contaminated tap water; inadequate disinfection and drying between uses in patients
121 Mycobacterium spp. (patients), M. chelonae and M. fortuitum (AER)150NoNo dataContaminated AER; endoscope reprocessing not described
142 S. marcescens 33PneumoniaYesInappropriate cleaning and disinfection (ethanol)
55 S. marcescens 40NoYesInappropriate disinfection (ethanol); rinsing with tap water
57 S. marcescens 65Bacteremia/sepsis, pneumonia, wound infectionYesInappropriate cleaning and disinfection; rinsing with tap water; lack of drying procedure
72 S. marcescens 53 (no data about endoscopy)YesBacteremia/sepsis, pneumonia, wound infectionYesDrying with no ethanol flushing
153 R. rubra 300NoNoContaminated cleaning brushes
69 R. rubra 110NoYesContaminated suction channel; drying with no ethanol flushing; disinfection procedure not described
156 Bacillus sp.100NoYesContaminated suction valves (no disassembling prior to cleaning); inappropriate cleaning and disinfection (ethanol)
54 M. mesophilicum 70NoNoRinsing with contaminated tap water; endoscope reprocessing not described
154 Blastomyces dermatitidis 20NoNot testedInadequate manual cleaning; drying procedure not described
155 Legionella pneumophila 30NoNot testedRinsing with contaminated tap water (inadequate maintenance of the filters)
143 Klebsiella pneumoniae, Proteus mirabilis, Morganella morganii, Proteus vulgaris 1170NoYesLoose biopsy port cap of the contaminated bronchoscope
  • a AER, automated endoscope reprocessor.