title: A Pseudo-Outbreak of Pseudomonas putida and Stenotrophomonas maltophilia in a Bronchoscopy Unit.
abstract: BACKGROUND
  Endoscopes represent the medical devices most commonly linked to health care-associated outbreaks and pseudo-outbreaks. Most of the recent outbreaks and pseudo-outbreaks have resulted from contaminated automated endoscope reprocessors (AER) or the use of damaged or malfunctioning bronchoscopes or contaminated equipment.
  
  
  OBJECTIVE
  We investigated a pseudo-outbreak of Pseudomonas putida and Stenotrophomonas maltophilia recovered from bronchial washing (BW) specimens obtained during bronchoscopy in a bronchoscopy unit.
  
  
  METHODS
  Samples were obtained from environmental surfaces in the endoscopy suite, bronchoscopes, and bronchoscopic dispensable material, and specimens of cleaning solutions, cleaning brushes, the AER, and the ultrasound system were sent for bacterial culture. Medical records were reviewed to identify possible infections after a bronchoscopy.
  
  
  RESULTS
  P. putida and S. maltophilia were isolated from BW samples of 39 patients. The bronchoscopy models Olympus BF-1T160 and BF-160 were contaminated. Both bronchoscopes and other contaminated material (cleaning brushes, diluted cleaning solutions, and the sink) were isolated, but new cases continued to appear. The AER was recently installed, and new connections were used for the water lines and new tubes were connected to the AER. Initially, specimens were obtained from the external circuits and the internal walls of the AER. Finally, cultures were made from the filters on the water lines, and growth of P. putida and S. maltophilia was found. The investigation revealed that the BW specimens were contaminated because sterile saline was injected by means of the biopsy port of the bronchoscope and was recovered through the same channel by means of the proximal suction port. No patients developed clinical signs or symptoms of infection, but the positive cultures did lead to treatment of 21 patients.
  
  
  CONCLUSIONS
  We described a pseudo-outbreak related to a contaminated bronchoscope because of inadequate installation of the AER for used new water lines and because the new tubes were connected to the AER. The antibacterial filters of the AER used tap water, and this may have contained low levels of microorganisms. No serious clinical complications derived from this pseudo-outbreak.
authors.affiliation: Bronchopleural Unit, Department of Pneumology, Hospital Álvaro Cunqueiro, NeumoVigo I+i Research Group, Research Institute Galicia Sur (IIS Galicia Sur) EOXI Vigo, Vigo, Spain.
authors.forename: Maribel
authors.initials: M
authors.lastname: Botana-Rial
authors.forename: Virginia
authors.initials: V
authors.lastname: Leiro-Fernández
authors.forename: Manuel
authors.initials: M
authors.lastname: Núñez-Delgado
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Álvarez-Fernández
authors.forename: Susana
authors.initials: S
authors.lastname: Otero-Fernández
authors.forename: Helena
authors.initials: H
authors.lastname: Bello-Rodríguez
authors.forename: Carlos
authors.initials: C
authors.lastname: Vilariño-Pombo
authors.forename: Alberto
authors.initials: A
authors.lastname: Fernández-Villar
mesh_terms: D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D020680:Bronchoscopes / Q000382:microbiology*; D001999:Bronchoscopy; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology*; D003951:Diagnostic Errors; D004196:Disease Outbreaks; D004866:Equipment Contamination; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000453:epidemiology*; D016958:Pseudomonas putida / Q000302:isolation & purification; D013030:Spain / Q000453:epidemiology; D020615:Stenotrophomonas maltophilia / Q000302:isolation & purification