A pseudo-outbreak of Aureobasidium species lower respiratory tract infections caused by reuse of single-use stopcocks during bronchoscopy.
OBJECTIVE
To investigate and control an apparent outbreak of lower respiratory tract infections due to Aureobasidium species.


METHODS
Outbreak investigation.


METHODS
University-affiliated medical center.


METHODS
Nine patients who underwent bronchoscopy between June and August 1998.


RESULTS
Ten bronchoalveolar lavage (BAL) fluid cultures from nine patients grew Aureobasidium species during the outbreak period; whereas, respiratory specimens from only two patients grew Aureobasidium species during the preceding 6 years. No patient was judged to have true infection due to Aureobasidium species either before or after bronchoscopy. Nine of the 10 bronchoscopies that yielded Aureobasidium species were performed in the outpatient bronchoscopy suite. The Aureobasidium isolates were not associated with any one bronchoscope. Observation of bronchoscopy procedure revealed that plastic stopcocks labeled for single use were reused on different patients during BAL. There was no record of how many times each stopcock was being reused. After each use, the stopcocks were placed in an automated disinfection machine designed for bronchoscopes. Culture of the stopcocks after they had been "disinfected" yielded a heavy growth of Aureobasidium species, while culture of fluid from the automated disinfection machine was negative. Reuse of the stopcocks was halted, and, during the following 6-month period, Aureobasidium species were not isolated from any BAL specimen.


CONCLUSIONS
Reuse of medical equipment labeled for single use is potentially hazardous, especially if no quality control system is in place to monitor sterility and function after reprocessing.
Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina 27710, USA.
S J
SJ
Wilson
R J
RJ
Everts
K B
KB
Kirkland
D J
DJ
Sexton
D018893:Bronchoalveolar Lavage; D020680:Bronchoscopes / Q000382:microbiology*; D003428:Cross Infection; D004196:Disease Outbreaks; D004866:Equipment Contamination; D017743:Equipment Reuse; D006801:Humans; D017053:Infection Control; D003904:Mitosporic Fungi / Q000302:isolation & purification / Q000472:pathogenicity*; D012141:Respiratory Tract Infections / Q000382:microbiology / Q000635:transmission*