DOES THE BRONCHOSCOPE PROPAGATE INFECTION

The flexible and rigid bronchoscopes traverse the nasopharynx or oroph arynx and carry with them the indigenous microbial flora to distal reg ions 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 lu ng parenchyma or, if the patient has preexisting infection, further sp read of infection locally or to extrapulmonary sites; (2) spread of in fection from one patient to another via the bronchoscope, if the metho ds of disinfection and sterilization are inadequate; and (3) pseudoinf ection due to cross-contamination of the bronchoscope, resulting in is olation of organisms from the bronchoscopic specimens of a patient who is clinically not infected. Review of the literature indicates that t he last-mentioned consequence is more commonly encountered in clinical practice. The occurrence of pseudoinfection inevitably leads to costl y and time-consuming procedures to guarantee that the patients are not infected. Rigorous adherence to sterilization and disinfection proced ures 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. T his can be accomplished by establishing a set of policies regarding di sinfection, sterilization, and protection of uninfected patients, as w ell as the bronchoscopist and paramedical personnel involved in bronch oscopy.