Nosocomial transmission of imipenem-resistant Pseudomonas aeruginosa following bronchoscopy associated with improper connection to the STERIS SYSTEM 1 processor

OBJECTIVE: To assess nosocomial transmission of imipenem-resistant Pseudomo nas aeruginosa (IRPA) following bronchoscopy during August through October 1998. DESIGN: Traditional and molecular epidemiological investigation of a case s eries. SETTING: University-affiliated community hospital. PATIENTS: 18 patients with IRPA bronchial-wash isolates. INTERVENTIONS: We reviewed clinical data, performed environmental cultures and molecular analysis of all IRPA isolates, and observed disinfection of b ronchoscopes. RESULTS: Of 18 patients who had IRPA isolated from bronchoscopic or postbro nchoscopic specimens, 13 underwent bronchoscopy for possible malignancy or undiagnosed pulmonary infiltrates. Following bronchoscopy, 3 patients conti nued to have IRPA isolated from sputum and demonstrated clinical evidence o f infection requiring specific antimicrobial therapy. The remaining 15 pati ents had no further IRPA isolated and remained clinically well 3 months fol lowing bronchoscopy. Pulsed-field gel electrophoresis revealed that all str ains except one were > 95% related. STERIS SYSTEM 1 had been implemented in July 1998 as an automatic endoscope reprocessor (AER) for all endoscopes a nd bronchoscopes. Inspection of bronchoscope sterilization cycles revealed incorrect connectors joining the bronchoscope suction channel to the STERIS SYSTEM 1 processor, obstructing peracetic acid flow through the bronchosco pe lumen. No malfunction warning was received, and spore strips remained ne gative. CONCLUSIONS: The similarity of diverse connectors and limited training by t he manufacturer regarding AER for bronchoscopes were the two factors respon sible for the outbreak. Appropriate connections were implemented, and there was no further bronchoscope contamination. We suggest active surveillance of all bronchoscopy specimen cultures, standardization of connectors of var ious scopes and automated processors, and systematic education of staff by manufacturers with periodic on-site observation (Infect Control Hosp Epidem iol 2001;22:409-413).