What is the key question?

• Although case series and case reports highlight serious concerns, there is a aucity of data regarding the rate of contamination of bronchoscopes and the rate of post-procedure infection directly related to this contamination.

What is the bottom line?

• In three Teritary referral centers including two transplant centers, researchers assessed 24 bronchoscopy procedures including EBUS scopes.
• This included observation of cleaning of scopes, high level disinfection quipment and policy, inspection for scope damage (using lighted magnification and novel “borescopes”), and contamination post cleaning using culture and tests for protein, haemoglobin and adenosine triphosphate (ATP). Reprocessing practises and storage cabinet cleanliness was evaluated by visual inspection and APT tests.
• The results were profound. All scopes had residual contamination and microbial growth was identified on 11/20 (55%) including bacteria (Stenotrophomonas maltophilia, Escherichia coli/Shigella spp) and mold (pathogens (Lecanicillium lecanii/Verticillium dahliae).
• All scopes had other visible irregularities including trauma.
• Reprocessing practises were substandard in two centers.

Why read on?

• It is unclear at this point what the contribution of these findings to post procedure infection and fever however regardless of the lack of this information these findings are concerning.
• Mycobacterial isolates, viral cultures and genomic analysis would undoubtedly identify further contamination.
• Even standard cleaning practises recommended by manufacturers and regional governance bodies may be inadequate and consideration needs to be given to the sterilization of bronchoscopes and cheaper disposable bronchoscopy.
• The reduction in size of bronchoscopes and new devices for peripheral lesions may further complicate cleaning.
• Prospective trials correlation contamination with infection re required.