Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-22T05:08:28.027Z Has data issue: false hasContentIssue false
  • English
  • Français

Pseudo-Outbreak of Mycobacterium chelonae and Methtlobactertum mesophilicum Caused by Contamination of an Automated Endoscopy Washer

Published online by Cambridge University Press:  02 January 2015

Amy Beth Kressel  and
Francine Kidd
Amy Beth Kressel*
Affiliation:
Department of Internal Medicine, University Hospital, Inc, Cincinnati, Ohio
Francine Kidd
Affiliation:
Division of Infectious Diseases, University of Cincinnati, and the Department of Infection Control, University Hospital, Inc, Cincinnati, Ohio
*
University of Cincinnati, PO Box 670560, Cincinnati, OH, 45267-0560
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate an unusual number of rapidly growing acid-fast bacilli, later identified as Mycobacterium chelonae, and pink bacteria, later identified as Methylo-bacterium mesophilicum, from fungal cultures obtained by bronchoscopy.

Design:

Outbreak investigation.

Setting:

An academic medical center performing approximately 500 bronchoscopies and 4,000 gastrointestinal endoscopies in 1998.

Patients:

Patients undergoing bronchoscopy July 21 to October 2, 1998.

Methods:

The infection control department reviewed patient charts and bronchoscopy logs; obtained cultures of source water, faucets, washers, unopened glutaraldehyde, glutaraldehyde from the washers, and endoscopes; observed endoscope and bronchoscope cleaning and disinfecting procedures; reviewed glutaraldehyde monitoring records; and sent M chelonae isolates for DNA fingerprinting.

Results:

M chelonae, M mesophilicum, gram-negative bacteria, and various molds grew from endoscopes, automated washers, and glutaraldehyde from the washers but not from unopened glutaraldehyde. The endoscopy unit regularly monitored the pH of glutaraldehyde, and the logs contained no deficiencies. The above sources remained positive for the same organisms after a glutaraldehyde cleaning cycle of the automated washers. DNA fingerprinting of the M chelonae revealed that they were clonally related.

Conclusions:

The automated washers were contaminated with a biofilm that rendered them resistant to decontamination. The washers then contaminated the endoscopes and bronchoscopes they were used to disinfect. Our institution purchased new endoscopes and a new paracetic acid sterilization system.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 7 , July 2001 , pp. 414 - 418
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.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.Google Scholar
2.Fraser, VJ, Jones, M, Murray, PR, Medoff, G, Zhang, Y, Wallace, J, et al.Contamination of flexible fiberoptic bronchoscopes with Mycobacterium chelonae linked to an automated bronchoscope disinfection machine. Am Rev RespirDis 1992;145:853–855.CrossRefGoogle Scholar
3.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.Google Scholar
4.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.CrossRefGoogle ScholarPubMed
5.Fraser, VJ, Zuckerman, G, Clouse, RE, O'Rourke, S, Jones, M, Klasner, J, et al.A prospective randomized trial comparing manual and automated endoscope disinfection methods. Infect Control Hosp Epidemiol 1993;14:383–389.CrossRefGoogle ScholarPubMed
6.Kovacs, BJ, Chen, YK, Kettering, JD, Aprecio, RM, Roy, I. High-level disinfection of gastrointestinal endoscopes: are current guidelines adequate? Am J Gastroenterol 1999;94:1546–1550.Google Scholar
7.Ascenzi, JM, Ezzell, RJ, Wendt, TM. More accurate method for measurement of tuberculocidal activity of disinfectants. Appl Environ Microbiol 1987;53:2189–2192.Google Scholar
8.Martin, MA, Reichelderfer, M. APIC guideline for infection prevention and control in flexible endoscopy. Am J Infect Control 1994;22:19–38.Google Scholar
9.Deva, AK, Vickery, K, Zou, J, West, RH, Selby, W, Benn, RAV, et al.Detection of persistent vegetative bacteria and amplified viral nucleic acid from in-use testing of gastrointestinal endoscopes. J Hosp Infect 1998;39:149–157.Google Scholar
10.Spach, DH, Silverstein, FE, Stamm, WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117–128.Google Scholar
11.Bronowicki, J-P, Venard, V, Botte, C, Monhoven, N, Gastin, I, Chone, L, et al.Patient-to-patient transmission of hepatitis C virus during colonoscopy. N Engl J Med 1997;337:237–240.CrossRefGoogle ScholarPubMed
12.Agerton, T, Valway, S, Gore, B, Pozsik, C, Plikaytis, B, Woodley, C, et al.Transmission of a highly drug-resistant strain (strain W1) of Mycobacterium tuberculosis: community outbreak and nosocomial transmission via a contaminated bronchoscope. JAMA 1997;278:1073–1077.Google Scholar
13.Centers for Disease Control and Prevention. Bronchoscopy-related infections and pseudoinfections—New York, 1996 and 1998. MMWR 1999;48:557–560.Google Scholar