A pseudo-outbreak of Aureobasidium species lower respiratory tract infections caused by reuse of single-use stopcocks during bronchoscopy

OBJECTIVE: To investigate and control an apparent outbreak of lower respira tory tract infections due to Aureobasidium species. DESIGN: Outbreak investigation. SETTING: University-affiliated medical center. PATIENTS: Nine patients who underwent bronchoscopy between June and August 1998. RESULTS: Ten bronchoalveolar lavage (BAL) fluid cultures from nine pa tients grew Aureobasidium species during the outbreak period; whereas, resp iratory specimens from only two patients grew Aureobasidium species during the preceding 6 years. No patient was judged to have true infection due to Aureobasidium species either before or after bronchoscopy Nine of the 10 br onchoscopies that yielded Aureobasidium species were performed in the outpa tient bronchoscopy suite. The Aureobasidium isolates were not associated wi th any one bronchoscope. Observation of bronchoscopy procedure revealed tha t plastic stopcocks labeled for single use were reused on different patient s during BAL. There was no record of how many times each stopcock was being reused. After each use, the stopcocks were placed in an automated disinfec tion machine designed for bronchoscopes. Culture of the stop cocks after th ey had been "disinfected" yielded a heavy growth of Aureobasidium species, while culture of fluid from the automated disinfection machine was negative . Reuse of the stopcocks was halted, and, during the following 6-month peri od, Aureobasidium species were not isolated from any BAL specimen. CONCLUSIONS: Reuse of medical equipment labeled for single use is potential ly hazardous, especially if no quality control system is in place to monito r sterility and function after reprocessing.