Caveat emptor: the role of suboptimal bronchoscope repair practices by a third-party vendor in a pseudo-outbreak of pseudomonas in bronchoalveolar lavage specimens.
OBJECTIVE
To describe a pseudo-outbreak associated with loose bronchoscope biopsy ports caused by inadequate bronchoscope repair practices by third-party vendors and to alert healthcare personnel to assess bronchoscope repair practices.


METHODS
Outbreak investigation.


METHODS
A 925-bed tertiary care hospital in Baltimore, Maryland.


METHODS
Patients who underwent bronchoscopy with certain bronchoscopes after they had been repaired by a third-party vendor.


METHODS
An epidemiologic investigation was conducted to determine the cause of Pseudomonas putida growth in 4 bronchoalveolar lavage (BAL) specimens within a 3-day period in May 2008. All bronchoscopes were inspected, and cultures were obtained from bronchoscopes and the environment. Bronchoscope cleaning and maintenance practices were reviewed. Microbiologic results from BAL specimens and medical records were reviewed to find additional cases.


RESULTS
All 4 case patients had undergone bronchoscopy with one of 2 bronchoscopes, both of which had loose biopsy ports. Bronchoscope cultures grew P. putida, Pseudomonas aeruginosa, and Stenotrophomonas. The P. putida strains from the bronchoscopes matched those from the patients. Specimens from 12 additional patients who underwent bronchoscopy with these bronchoscopes grew P. putida, P. aeruginosa, or Stenotrophomonas. No patients developed clinical signs or symptoms of infection, but 7 were treated with antibiotics. Investigation revealed that the implicated bronchoscopes had been sent to an external vendor for repair; examination by the manufacturer revealed irregularities in repairs and nonstandard part replacements.


CONCLUSIONS
Third-party vendors without access to proprietary information may contribute to mechanical malfunction of medical devices, which can lead to contamination and incomplete disinfection.
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. scosgro1@jhmi.edu
Sara E
SE
Cosgrove
Polly
P
Ristaino
Anne
A
Caston-Gaa
Donna P
DP
Fellerman
Elaine F
EF
Nowakowski
Karen C
KC
Carroll
Trish M
TM
Perl
Lisa L
LL
Maragakis
D001999:Bronchoscopy / Q000009:adverse effects*; D003428:Cross Infection / Q000209:etiology*; D006801:Humans