A bronchoscope is disinfected by which disinfectant?

NORCET 2 - 2021 (shift-1)

Applied Microbiology & Infection control

Hard

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

A bronchoscope is a semi-critical instrument that requires high-level disinfection (HLD) because it contacts mucous membranes.
Glutaraldehyde is a high-level disinfectant that effectively kills a broad spectrum of microorganisms, including vegetative bacteria, mycobacteria, fungi, viruses, and, with sufficient contact time, bacterial spores.
It is a chemical sterilant that is compatible with the heat-sensitive materials used in flexible endoscopes, unlike heat sterilization (autoclaving).
A 2% alkaline glutaraldehyde solution is a standard choice for the manual disinfection of endoscopes, requiring specific immersion time and temperature for efficacy.

Option B: Ethyl alcohol is an intermediate-level disinfectant. It is not effective against bacterial spores and some viruses, making it inadequate for high-level disinfection of a semi-critical device like a bronchoscope.
Option C: Sodium hypochlorite (bleach) is a powerful high-level disinfectant, but it is highly corrosive to the metal, plastic, and rubber components of flexible endoscopes, causing significant damage.
Option D: Isopropyl alcohol, like ethyl alcohol, is an intermediate-level disinfectant. It is not sporicidal and does not meet the requirements for high-level disinfection needed for a bronchoscope.

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Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain High-level disinfection of semi-critical medical devices as background academic context rather than a clinical decision trigger.
Proper disinfection of bronchoscopes is a critical patient safety issue. Inadequate cleaning and disinfection can lead to the transmission of serious respiratory pathogens (e.g., Pseudomonas aeruginosa, Mycobacterium tuberculosis) between patients.
Nurses working in endoscopy or respiratory units must be vigilant about following reprocessing protocols, including correct contact time, temperature, and concentration of the disinfectant.
What if? If a hospital transitions to an automated endoscope reprocessor (AER), the nurse's role shifts from manual soaking to correctly loading the machine, selecting the cycle, and ensuring the machine uses the correct HLD (which might be glutaraldehyde, peracetic acid, or OPA) and completes its cycle successfully.

How to Approach the Question

First, identify the medical device in the question: a bronchoscope.
Next, classify the device based on its use and risk of infection (Spaulding Classification). A bronchoscope enters the airways (mucous membranes), so it is a 'semi-critical' item.
Recall the required level of processing for a semi-critical item. This is High-Level Disinfection (HLD), which kills all microorganisms except high numbers of bacterial spores.
Evaluate the given options. Ask yourself which of these agents is a High-Level Disinfectant that is also compatible with a delicate, heat-sensitive endoscope.
Eliminate alcohols (Ethyl, Isopropyl) as they are intermediate-level disinfectants.
Eliminate Sodium Hypochlorite because, while a HLD, it is too corrosive for endoscopes.

Concept Tested & Keywords

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