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bronchoscopy: Arjun Srinivasan, Linda L. Wolfenden, Xiaoyan Song, Trish M. Perl, and Edward F. Haponik Bronchoscope Reprocessing and Infection Prevention and Control: Bronchoscopy-Specific Guidelines Are Needed Chest 2004; 125: 307-314 [Abstract] [Full text] [PDF]

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Bronchoscope reprocessing: Are changes needed?

Lawrence F Muscarella, PhD   (14 January 2004)

Bronchoscope reprocessing: Are changes needed? 14 January 2004
Lawrence F Muscarella, PhD, Director, Research and Development Custom Ultrasonics, Inc. Send letter to journal: Re: Bronchoscope reprocessing: Are changes needed? LFM{at}myendosite.com Lawrence F Muscarella, PhD	I am responding to the recently published article: Srinivasan A, et al. Bronchoscope Reprocessing and Infection Prevention and Control: Bronchoscopy-Specific Guidelines Are Needed. Chest 2004 125: p. 307-314. I agree with these authors and would like to provide the following additional recommendations: First, in agreement with Srinivasan A, et al., to request professional organizations develop bronchoscope-specific, comprehensive reprocessing guidelines that provide step-by-step instructions similar to those developed for reprocessing gastrointestinal endoscopes (e.g., http://www.sgna.org/resources/guideline3.cfm). The intent of developing these guidelines is to reduce confusion and standardize care and reprocessing policies. Second, based on a review of the medical literature, to express the concern as potentially unsafe the too common clinical practice of using 'just-reprocessed-and-soaking-wet-with-rinse-water' bronchoscopes and other types of flexible endoscopes. It is recommended that the standard of care be raised to require drying of the endoscope after reprocessing (and water rinsing) and before reuse, to prevent bacterial transmission and nosocomial infection. (Also see: http://www.myendosite.com/ORTodayDec2003.pdf) Third, due to the potential for bacterial contamination of the endoscope during terminal water rinsing, to recommend professional organizations evaluate the importance of microbiologically monitoring the rinse water used during endoscope reprocessing (see: Muscarella LF. Application of environmental sampling to flexible endoscope reprocessing: the importance of monitoring the rinse water. Infect Control Hosp Epidemiol. 2002 May;23(5):285-9). And, fourth, for the sake of clarity, completeness, and patient safety, to recommend inclusion of the following recommendation into all relevant endoscope reprocessing guidelines: Irrespective of the claim of the LCG or AER (i.e., "high-level disinfection" or "sterilization"), or the quality of the water used to for rinsing (e.g., tap water, "bacteria- free" water, or water labeled as "sterile"), dry the endoscope after reprocessing both between patient procedures and prior to storage. Drying can be achieved by flushing each of the endoscope’s internal channels with 70% alcohol followed by forced air.