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Travis HS, Russell RV, Kovaleva J. Cross-contamination rate of reusable flexible bronchoscopes: A systematic literature review and meta-analysis. J Infect Prev 2023; 24:95-102. [PMID: 37065274 PMCID: PMC10090576 DOI: 10.1177/17571774231158203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/25/2023] [Indexed: 02/27/2023] Open
Abstract
Background Bronchoscopy is generally a safe and efficient procedure. However, the risk of cross-contamination with reusable flexible bronchoscopes (RFB) has been detected in several outbreaks worldwide. Aim To estimate the average cross-contamination rate of patient-ready RFBs based on available published data. Methods We performed a systematic literature review in PubMed and Embase to investigate the cross-contamination rate of RFB. Included studies identified indicator organisms or colony forming units (CFU) levels, and total number of samples >10. The Contamination threshold was defined according to the European Society of Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy Nurse and Associates (ESGE-ESGENA) guidelines. To calculate the total contamination rate, a random effects model was applied. Heterogeneity was analysed via a Q-test and illustrated in a forest plot. Publication bias was analysed via the Egger’s regression test and illustrated in a funnel plot. Results Eight studies fulfilled our inclusion criteria. The random effects model included 2169 samples and 149 events (positive tests). The total RFB cross-contamination rate was 8.69% ± 1.86 (standard division [SD]) (95% confidence interval [CI]: 5.06–12.33%). The result showed significant heterogeneity of 90% and publication bias. Discussion Significant heterogeneity and publication bias is likely associated with varying methodology and aversion towards publishing negative findings, respectively. Based on the cross-contamination rate an infection control paradigm shift is needed to ensure patient safety. We recommend to follow the Spaulding classification and classify RFBs as critical items. Accordingly, infection control measures such as obligatory surveillance, and implementing single-use alternatives must be considered where feasible.
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Affiliation(s)
| | | | - Julia Kovaleva
- Clinical Microbiologist/Clinical Pathologist, Labo Nuytinck-Anacura, Evergem, Belgium
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Martin-Loeches I, Leone M, Einav S. Antibiotic prophylaxis in the ICU: to be or not to be administered for patients undergoing procedures? Intensive Care Med 2019; 46:364-367. [PMID: 31781837 PMCID: PMC7224040 DOI: 10.1007/s00134-019-05870-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/16/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, P.O. Box 580, James's Street, Dublin 8, Ireland. .,Respiratory Institute, Pulmonary Intensive Care Unit, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain.
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Medicine, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Aix-Marseille Université, Marseille, France
| | - Sharon Einav
- General Intensive Care Unit, Shaare Zedek Medical Centre, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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