A pseudoepidemic of Mycobacterium chelonae: contamination of a bronchoscope and autocleaner.
BACKGROUND
At fibreoptic bronchoscopy the potential exists for contamination of bronchoscopes and microbiological specimens. Patients may also be cross infected with acid fast bacilli (AFB). During a five month period, 12 bronchial wash specimens of 65 patients undergoing bronchoscopy, one bronchoscope and an autocleaner, were contaminated with the AFB, Mycobacterium chelonae (MCH).


OBJECTIVE
To eradicate AFB contamination of bronchoscopy specimens by identifying sources of contamination and modifying disinfection procedures.


METHODS
To identify the source of contamination, samples for AFB culture were taken from three bronchoscopes, the autocleaner and water taps. To eradicate MCH contamination, the bronchoscopes were soaked in 2% glutaraldehyde overnight and flushed with 70% alcohol. Disinfection procedures were altered by using sterile water and containers in cleaning. Autocleaner use was discontinued.


RESULTS
The autocleaner, one bronchoscope and 12 bronchial wash specimens were contaminated with MCH. All contaminants had similar electrophoretic banding on probing of their DNA fragments, suggesting a common clone of origin. After the alterations in disinfection procedures and despite prolonged soaking in 2% glutaraldehyde, three further contaminated wash specimens were isolated from one bronchoscope. Only after ethylene oxide sterilisation of this bronchoscope was the contamination overcome. Since then no further MCH contamination has occurred. No patient required treatment and there has been no clinical evidence of mycobacterial disease.


CONCLUSIONS
To avoid contamination of bronchoscopy specimens with MCH, use of autoclearners should be discouraged and sterile water and containers used in cleaning procedures. If MCH contamination occurs in this setting, the bronchoscope and dismantled valve mechanism should undergo ethylene oxide sterilisation.
Campagnaro
R L
RL
Department of Respiratory Medicine, Western Hospital, Melbourne, Vic.
Teichtahl
H
H
Dwyer
B
B
D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D020680:Bronchoscopes; D004203:Disinfection / Q000295:instrumentation* / Q000379:methods; D004866:Equipment Contamination; D005027:Ethylene Oxide; D005976:Glutaral; D006801:Humans; D016926:Mycobacterium chelonae / Q000145:classification / Q000254:growth & development / Q000302:isolation & purification*; D013242:Sterilization / Q000379:methods; D014739:Victoria
D005027:Ethylene Oxide; D005976:Glutaral