Does the Bronchoscope Propagate Infection?

The flexible and rigid bronchoscopes traverse the nasopharynx or oropharynx and carry with them the indigenous microbial flora to distal regions and may thus inoculate the tracheobronchial tree and possibly the pulmonary parenchyma. The three potential consequences of this event include: (1) onset of new infection in the tracheobronchial tree or lung parenchyma or, if the patient has preexisting infection, further spread of infection locally or to extrapulmonary sites; (2) spread of infection from one patient to another via the bronchoscope, if the methods of disinfection and sterilization are inadequate; and (3) pseudoinfection due to cross-contamination of the bronchoscope, resulting in isolation of organisms from the bronchoscopic specimens of a patient who is clinically not infected. Review of the literature indicates that the last-mentioned consequence is more commonly encountered in clinical practice. The occurrence of pseudoinfection inevitably leads to costly and time-consuming procedures to guarantee that the patients are not infected. Rigorous adherence to sterilization and disinfection procedures and a commonsense approach to protecting the uninfected patients and bronchoscopy personnel from infected patients and instruments will prevent the risk of propagating infection through the bronchoscope. This can be accomplished by establishing a set of policies regarding disinfection, sterilization, and protection of uninfected patients, as well as the bronchoscopist and paramedical personnel involved in bronchoscopy.