CHEST Guidelines-Burying-Our-Heads-in-the-Sand

Burying-Our-Heads-in-the-Sand_chest

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The article discusses the risks and realities of cross-contamination during bronchoscopy, emphasizing that infection control remains a significant concern despite technological advancements. The authors, Atul C. Mehta and Thomas Gildea from the Cleveland Clinic, argue that breaches in disinfection protocols often lead to cross-contamination. They commend a recent study by Ofstead and colleagues that highlights these risks and presents alarming findings on biological contamination post-reprocessing of bronchoscopes.<br /><br />In the study, all bronchoscopes tested showed human protein traces after high-level disinfection (HLD), and more than half had pathogens present. This was linked to visible irregularities in reprocessing procedures across study sites. Such findings suggest that current cleanup practices and protocols are inadequate, raising questions about the efficacy of manufacturers' guidelines and the need for enhanced training and oversight.<br /><br />The authors underline that the issue is both clinical and operational, noting that bronchoscopy-related infections are likely underrecognized or underreported. They cite previous reviews indicating instances of infection post-procedure but suggest these may only reflect a fraction of actual cases due to the lack of routine infection surveillance. Moreover, the enthusiasm for increasingly sophisticated bronchoscopy technology is expected to exacerbate the problem without appropriate reprocessing advancements.<br /><br />The editorial calls for proactive measures, such as regular assessment of HLD processes, adherence to rigorous standards and guidelines, proper maintenance of equipment, and exploration of new protocols like borescope inspection. The article emphasizes that ensuring patient safety might necessitate a shift from HLD to sterilization or even the adoption of disposable bronchoscopes, though these measures bring additional challenges. The authors urge the pulmonary community to address these significant risks and enhance procedural safety.

Keywords

cross-contamination

bronchoscopy

infection control

disinfection protocols

biological contamination

reprocessing procedures

infection surveillance

patient safety

bronchoscopes

pulmonary community