INFECTION CONTROL IN THE BRONCHOSCOPY SUITE : A Review - 08/09/11

Doi : 10.1016/S0272-5231(05)70123-4

Atul C. Mehta, MD, FCCP, FACP ^a, Omar A. Minai, MD ^b

^a Section of Bronchology (ACM)

^b Department of Pulmonary and Critical Care Medicine (OAM), The Cleveland Clinic Foundation, Cleveland, Ohio

Résumé

Bronchoscopy was once thought to carry little or no risk of spreading infection. For example, a 1976 study of 48,000 flexible bronchoscopy procedures found 10 deaths but none caused by infection.^{97 Suratt P.M., Smiddy J.F., Gruber B. Deaths and complications associated with fiberoptic bronchoscopy Chest 1976 ; 69 : 747-751 [cross-ref]

Cliquez ici pour aller à la section Références} The AIDS and tuberculosis epidemics, however, made clinicians and patients concerned about infection. Reports of infections transmitted by bronchoscopy have confirmed that the concerns are justified,^{2 Agerton T., Valway S., Gore B. , et al. Transmission of a highly drug-resistant strain of Mycobacterium tuberculosis. JAMA 1997 ; 278 : 1073-1077

Cliquez ici pour aller à la section Références, 63 Michele T.M., Cronin W.A., Graham N.M.H. , et al. Transmission of Mycobacterium tuberculosis by a fiberoptic bronchoscope: Identification by DNA fingerprinting JAMA 1997 ; 278 : 1093-1095

Cliquez ici pour aller à la section Références} but as of yet, little guidance is available for clinicians who want to learn more about possible routes of infection and reduce the risk of infection.^{77 Prakash U.B.S. Does the bronchoscope propagate infection? Chest 1993 ; 104 : 552-559 [cross-ref]

Cliquez ici pour aller à la section Références}

We searched the Medline database to identify 114 articles/abstracts on the topic from 1966 to 1998. Because of the nature of the topic and in an effort to make this a comprehensive review, even dated but relevant articles were included. Although the papers sometimes contradict each other, and many of them are case studies, the literature as a whole suggests that bronchoscopy may support three routes of disease transmission: contaminated equipment may infect healthy patients; patient coughing can transmit infection through the air; and equipment may spread organisms from one site to another within a single patient. We conclude this article with a list of recommendations for infection control in the bronchoscopy suite, based in part on the literature review and in part on our clinical experience. Strict, consistent adherence to infection control protocols should reduce or eliminate nosocomial infections caused by bronchoscopy.

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Plan

MODES OF TRANSMISSION

Cross-Contamination

Airborne Transmission

Distal Spread

PREVENTION

Address reprint requests to Atul C. Mehta, MD, FCCP, FACP, Department of Pulmonary and Critical Care Medicine, Desk A-90, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195