Nosocomial Transmission of Imipenem-Resistant Pseudomonas Aeruginosa Following Bronchoscopy Associated With Improper Connection to the STERIS SYSTEM 1 Processor

Infection Control

Volumn 22, Issue 7, 2001, Pages 409-413

  Sorin, Mircea ^a   Segal Maurer, Sorana ^a   Mariano, Noriel ^a   Urban, Carl ^a   Combest, Anna ^a   Rahal, James J ^a  

^a NEW YORK PRESBYTERIAN HOSPITAL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

IMIPENEM;

AGED; ANTIBIOTIC RESISTANCE; ARTICLE; AUTOMATION; BACTERIUM ISOLATION; BRONCHOSCOPY; CLINICAL ARTICLE; CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; CONTROLLED STUDY; DISEASE TRANSMISSION; ENDOSCOPE; FEMALE; FOOD AND DRUG ADMINISTRATION; HUMAN; MALE; PSEUDOMONAS AERUGINOSA; PULSED FIELD GEL ELECTROPHORESIS; RANDOMIZED CONTROLLED TRIAL; STANDARD;

BRONCHOSCOPES; CROSS INFECTION; DISEASE OUTBREAKS; DISINFECTION; DRUG RESISTANCE, BACTERIAL; EQUIPMENT CONTAMINATION; FEMALE; HOSPITALS, TEACHING; HUMANS; IMIPENEM; MALE; NEW YORK CITY; PSEUDOMONAS AERUGINOSA; PSEUDOMONAS INFECTIONS; SPUTUM; THIENAMYCINS;

EID: 0034826490     PISSN: 01959417     EISSN: 23279451     Source Type: Journal    
DOI: 10.1086/501925     Document Type: Article

References (45)

1. Favero MS. Strategies for disinfection and sterilization of endoscopes: the gap between basic principles and actual practice. Infect Control Hosp Epidemiol 1991;12:279–281.
2. Reichert M. Automatic washers/disinfectors for flexible endoscopes. Infect Control Hosp Epidemiol 1991;12:497–499.
3. Crow S. Peracetic acid sterilization: a timely development for a busy healthcare industry. Infect Control Hosp Epidemiol 1992;13:111–113.
4. Wallace CG, Agee PM, Demicco DD. Liquid chemical sterilization using peracetic acid: an alternative approach to endoscope processing. ASAIO Journal 1995;41:151–154.
5. Muscarella LF. High-level disinfection or “sterilization” of endoscopes? Infect Control Hosp Epidemiol 1996;17:183–187.
6. Rutala WA, Gergen MF, Weber DJ. Comparative evaluation of the sporicidal activity of new low-temperature sterilization technologies: ethylene oxide, 2 plasma sterilization systems, and liquid peracetic acid. Am J Infect Control 1998;26:393–398.
7. Alfa MJ, Degagne P, Olson N, Hizon R. Comparison of liquid chemical sterilization with peracetic acid and ethylene oxide sterilization for long narrow lumens. Am J Infect Control 1998;26:469–477.
8. Rutala WA, Weber DJ. Clinical effectiveness of low-temperature sterilization technologies. Infect Control Hosp Epidemiol 1998;19:798–804.
9. Rutala WA, Weber DJ. Disinfection of endoscopes: review of new chemical sterilants used for high-level disinfection. Infect Control Hosp Epidemiol 1999;20:69–76.
10. Reducing endoscopic contamination levels: are liquid disinfecting and sterilizing reprocessors the solution? Health Devices 1994;23:212–253.
11. Bradley CR, Babb JR, Ayliffe GAJ. Evaluation of the STERIS System 1 peracetic acid endoscope processor. J Hosp Infect 1995;29:143–151.
12. Webb SF, Val-Spinosa A. Outbreak of Serratia marcescens associated with the flexible fiberbronchoscope. Chest 1975;68:703–708.
13. Sammartino MT, Israel RH, Magnussen CR. Pseudomonas aeruginosa contamination of fibreoptic bronchoscopes. J Hosp Infect 1982;3:65–71.
14. Goldstein B, Abrutyn E. Pseudo-outbreak of Bacillus species: related to fibreoptic bronchoscopy. J Hosp Infect 1985;6:194–200.
15. Centers for Disease Control and Prevention. Nosocomial infection and pseudoinfection from contaminated endoscopes and bronchoscopes-Wisconsin and Missouri. MMWR 1991;40:675–678.
16. Whitlock WL, Dietrich RA, Steimke EH, Tenholder MF. Rhodotorula rubra contamination in fiberoptic bronchoscopy. Chest 1992;102:1516–1519.
17. Fraser VJ, Jones M, Murray PR, Medoff G, Zhang Y, Wallace RJ Jr. Contamination of flexible fibreoptic bronchoscopes with Mycobacterium chelonae linked to an automated bronchoscope disinfecting machine. Am Rev Respir Dis 1992;145:853–855.
18. Vandenbroucke-Grauls CM, Baars AC, Visser MR, Hulstaert PF, Verhoef J. An outbreak of Serratia marcescens traced to a contaminated bronchoscope. J Hosp Infect 1993;23:263–270.
19. Spach DH, Silverstein FE, Stamm WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117–128.
20. Bryce EA, Walker M, Bevan C, Smith JA. Contamination of bronchoscopes with Mycobacterium tuberculosis. Can J Infect Control 1993;8:35–36.
21. Kolmos HJ, Lerche A, Kristoffersen K, Rosdahl VT. Pseudo-outbreak of Pseudomonas aeruginosa in HIV-infected patients undergoing fiberoptic bronchoscopy. Scand J Infect Dis 1994;26:653–657.
22. Maloney S, Welbel S, Daves B, Adams K, Becker S, Bland L, et al. Mycobacterium abscessus pseudoinfection traced to an automated endoscope washer: utility of epidemiologic and laboratory investigation. J Infect Dis 1994;169:1166–1169.
23. Takigawa K, Fujita J, Negayama K, Terada S, Yamaji S, Kawanashi K, et al. Eradication of contaminating Mycobacterium chelonae from bronchofibrescopes and an automated bronchoscope disinfection machine. Respir Med 1995;89:423–427.
24. Reeves DS, Brown NM. Mycobacterial contamination of fibreoptic bronchoscopes.J Hosp Infect 1995;30(suppl):S531-S536.
25. Hagan ME, Klotz SA, Bartholomew W, Potter L, Nelson M. A pseudoepidemic of Rhodotorula rubra: a marker for microbial contamination of the bronchoscope. Infect Control Hosp Epidemiol 1995;16:727–728.
26. Mitchell DH, Hicks LJ, Chiew R, Montanaro JC, Chen SC. Pseudoepidemic of Legionella pneumophila serogroup 6 associated with contaminated bronchoscopes. J Hosp Infect 1997;37:19–23.
27. Agerton T, Valway S, Gore B, Pozsik C, Plikaytis B, Woodley C, et al. Transmission of a highly drug-resistant strain of Mycobacterium tuberculosis: community outbreak and nosocomial transmission via a contaminated bronchoscope. JAMA 1997;278:1073–1077.
28. Bond M, Huver B, Alexander D. Mycobacterium tuberculosis contamination of a bronchoscope. Presented at the 27th Annual Meeting of the American Practitioners in Infection Control; June 20–24, 1999; Baltimore, MD. P 220.
29. Alvarado CJ, Stolz SM, Maki DG. Nosocomial infections from contaminated endoscopes: a flawed automated endoscope washer. An investigation using molecular epidemiology. Am J Med 1991;91(suppl 3B):272S-280S.
30. Blanc DS, Parret T, Janin B, Raselli P, Francioli P. Nosocomial infections and pseudoinfections from contaminated bronchoscopes: two-year follow-up using molecular markers. Infect Control Hosp Epidemiol 1997;18:134–136.
31. Strelczyk K. Pseudo-outbreak of acid-fast bacilli. Presented at the 27th Annual Meeting of the American Practitioners in Infection Control; June 20–24, 1999; Baltimore, MD. P 198.
32. Curchoe R, Scott A. Investigating a pseudo-outbreak of Mycobacterium fortuitum. Presented at the 27th Annual Meeting of the American Practitioners in Infection Control; June 20–24, 1999; Baltimore, MD. P 197.
33. Centers for Disease Control and Prevention. Bronchoscopy-related infections and pseudo-infections-New York, 1996 and 1998. MMWR 1999;48:557–560.
34. Cronmiller JR, Nelson DK, Salman G, Jackson DK, Dean RS, Hsu JJ, et al. Antimicrobial efficacy of endoscopic disinfection procedures: a controlled, multifactorial investigation. Gastrointest Endosc 1999;50:152–158.
35. Maslow JN, Slutsky AM, Arbeit RD. Application of pulsed-field gel electrophoresis to molecular epidemiology. In: Persing DH, Smith TF, Tenover FC, White TJ, eds. Diagnostic Molecular Microbiology: Principles and Applications. Washington, DC: American Society for Microbiology; 1993;7.1:563–572.
36. Harvey J, Yates M. Do you clean or contaminate your bronchoscope? Respir Med 1996;90:63–67.
37. McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999;12:147–179.
38. Fraise AP. Disinfection in endoscopy. Lancet 1995;34:787–788.
39. Rutala WA, Weber DJ. Low-temperature sterilization technologies: do we need to redefine “sterilization”? Infect Control Hosp Epidemiol 1996;17:87–91.
40. Jackson J, Leggett JE, Wilson D, Gilbert DN. Mycobacteria gordonae in fibreoptic bronchoscopes. Am J Infect Control 1996;24:19–23.
41. Mannion PT. The use of peracetic acid for the reprocessing of flexible endoscopes and rigid cystoscopes and laparoscopes. J Hosp Infect 1995;29:313–315.
42. Alfa MJ. Importance of lumen flow in liquid chemical sterilization. Am J Infect Control 1999;27:373–374.
43. Rutala WJ, Gergen MF, Weber D. Reply. Am J Inject Control 1999;27:374–375.
44. Bond WW. Biological indicators for a liquid chemical sterilizer: a solution to the instrument reprocessing problem? Infect Control Hosp Epidemiol 1993;4:309–312.
45. Feigal DW Jr., Hughes JM. Infections from endoscopes inadequately reprocessed by an automated endoscope reprocessing system. FDA and CDC Public Health Advisory, DHHS, September 10, 1999. www.fda.gov/cdrh/safety/endoreprocess.pdf.