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This study investigated the source of a Pseudomonas aeruginosa outbreak associated with flexible bronchoscopes that occurred at the Johns Hopkins Hospital, Baltimore, USA from June 2001 to January 2002 and compared it with an 11 month baseline period. During the outbreak 414 patients underwent 665 bronchoscopic procedures. The rate of recovery of P aeruginosa increased from 10.4% at baseline to 31.0% during the outbreak (relative risk 2.97; 95% confidence interval 2.28 to 3.90). To find the source of infection specimens were cultured from bronchoscopes, automated endoscope reprocessors, and sink drains and sterilisation procedures were checked. All cultures except those from three bronchoscopes were negative for P aeruginosa. It was then discovered that these three bronchoscopes had been part of a national recall issued in November 2001 because they had loose biopsy caps, potentially leading to ineffective disinfection.
This study shows that bronchoscopy design faults can be sources of infection and emphasises the need for close surveillance to detect infections. It also highlights the need for more effective national recall systems for defective medical equipment.
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