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Bronchial Aspirates in the Diagnosis of Pulmonary Tuberculosis: bronchoscopes

Bronchial Aspirates in the Diagnosis of Pulmonary Tuberculosis: bronchoscopesIn these cases, it has been suggested that the disinfection procedures used were not performed thoroughly before the use of the bronchoscopes on subsequent patients. Carricajo et al showed experimentally that it is possible to obtain positive amplification results for M tuberculosis from the washing fluids of a bronchoscopic channel, even after the bronchoscope was disinfected by a 1-h exposure to 2% glutaraldehyde. Michele et al confirmed the transmission of M tuberculosis via a fiberoptic bronchoscope, using DNA fingerprinting analysis. Although Wong et al demonstrated an increased sensitivity of PCR on bronchial aspirates in the diagnosis of pulmonary tuberculosis, the false-positive rate was unacceptably high. However, until now, there has been no systematic research into the potential for false-positive results in amplification-based diagnostic techniques for M tuberculosis using bronchial aspirate specimens. This is because amplification-based techniques are more sensitive than conventional bacteriological studies, and positive results can arise from the amplification of DNA from even a few dead M tuberculosis bacilli other canadian health care mall.

As bronchoscopes are semicritical devices that come into contact with mucus membranes during use, they should be sterilized or at least undergo high-level disinfection. High-level disinfection is defined as the inactivation of all vegetative bacteria, mycobacteria, fungi, and viruses, but not necessarily all bacterial endospores. To meet the requirement for disinfection of endoscopes, a US Environmental Protection Agency-registered liquid sterilant/disinfectant, with objective evidence of efficacy, should be used. Of these, 2% glutaraldehyde has been widely used. The APIC recommends disinfection of endoscopes for at least 20 min, to achieve adequate high-level disinfection. Some previous guidelines have recommended a disinfection procedure of 30 to 40 min or more. In addition, careful cleaning before the disinfection procedure is also important in preventing the transmission of infectious organisms via bronchoscopes.