Compliance with the recommended bronchoscope decontamination and bacterial status of reprocessed equipment at the bronchoscopy unit, National Hospital, Sri Lanka in 2017-2018

Introduction: Insufficient cleaning and disinfection of bronchoscopes have been associated with transmission of infections among patients undergoing bronchoscopy.
Methods: A descriptive, cross-sectional study was conducted at the bronchoscopy unit of National Hospital, Sri Lanka from 4^th December 2017 to 31^st March 2018. We observed 93 bronchoscopy reproducing cycles. Sample collection and processing followed the European Society of Gastrointestinal Endoscopy guideline for quality assurance and reprocessing (Microbiological surveillance testing in endoscopy).1
A washout sample from the bronchoscopy channel and two swabs from the tip of the bronchoscope before and after reprocessing were collected. Washout samples were processed to estimate the total microbial count. Washout and swabs were cultured aerobically to detect indicator organisms i.e. Escherichia coli, other Enterobacteriaceae, Enterococci, Pseudomonas aeruginosa, other non-fermenters, Staphylococcus aureus, Staphylococcus epidermidis, mycobacteria and Legionella sp. Washouts having colony counts of ≥ 20/channel and/or having indicator organism/s were considered ‘contaminated’. Swabs were considered ‘contaminated’ if indicator organisms were present.
Results: Adherence to guidelines was 100% for cleaning valves and tips, 54% for fresh use of detergent, 50% for decontamination of trays and 50% for using sterile water. Sixty-seven (72%) samples were ‘contaminated’. Organisms found in washouts were P. aeruginosa (98%) and M. tuberculosis (2%). Swabs collected from the tip after reprocessing were contaminated in 16% of cycles, with P. aeruginosa (93%) being the prominent organism.
Conclusion: Deficiencies were noted in adherence to steps recommended by the Infection Prevention and Control Unit for reprocessing of bronchoscopes. Contamination was identified in the working lumen and bronchoscope tips after reprocessing, predominantly with P. aeruginosa and M. tuberculosis.