Bronchoscope, disinfection

Tuberculosis is on the increase in developed countries such as the USA and UK furthermore, MAI may be associated with AIDS sufferers. Hospital-acquired opportunistic mycobacteria may cause disseminated infection and also lung infections, endocarditis and pericarditis. Transmission of mycobacterial infection by endoscopy is rare, despite a marked increase in the use of flexible fibreoptic endoscopes, but bronchoscopy is probably the greatest hazard for the transmission ofM tuberculosis and other mycobacteria. Thus, biocides used for bronchoscope disinfection must be ehosen carefully to ensure that such transmission does not occur. 

Critical instruments come into direct contact with the patient s bloodstream or other sterile areas of the body. Examples of critical instruments include needles, surgical instruments used within the body, IV catheters, peritoneal endoscopes, and kidney dialysis membranes. Semicritical instruments must be free of pathogenic organisms. Examples of semicritical instruments are gastrointestinal endoscopes, bronchoscopes, vaginal speculums, respiratory care devices, and anesthesia equipment. Semicritical instruments must, at a minimum, require high-level disinfecting. 

These authors have suggested that glutaraldehyde- and succinal-dehyde-based products are the only disinfectants suitable for the decontamination of endoscopes [272], although a recent report proposes the use of 0.5% phthalaldehyde, which achieves a 5-log reduction in bacterial load, does not require dilution and does not emit irritating vapours as with other aldehydes [296]. Alternative agents have also been proposed in experiments designed to evaluate the efficacy of disinfection of bronchoscopes contaminated with M. tuberculosis or MAI [297]. 

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