A retrospective evaluation of pre-bronchoscopy gargling for the prevention of bronchoscopy-related infection

Background: Routine gargling with tap water prior to bronchoscopy for the prevention of infection has been performed in our hospital since 2017. Objectives: To study the preventive effect of gargling against bronchoscopy-related infection. Methods: A total of 2,044 patients underwent transbronchial biopsy under X-ray fluoroscopy between January 2014 and December 2018 at our hospital. We selected patients who were considered to have bronchoscopy-related infection through an examination of symptoms, chest x-ray images, computed tomography findings, and blood test findings among those treated with antibiotics (excluding prophylaxis) within 14 days after bronchoscopy. The rate of bronchoscopy-related infection was retrospectively compared between the periods prior to and after the introduction of pre-bronchoscopy gargling (i.e., 2014–2016 and 2017–2018, respectively). There was no change in the bronchoscopy procedure during the entire examined period. Results: Twenty patients (0.98%) experienced a bronchoscopy-related infection. Among those, 16 patients had lung cancer (12 adenocarcinomas and four squamous cell carcinomas), two patients had Mycobacterium avium complex disease, and two patients had other diseases. The rate of infection in the periods prior to and after the introduction of gargling, was 1.36% (17/1,253 patients) and 0.38% (3/791 patients), respectively (p=0.0358). Computed tomography revealed the presence of a low-density area or cavity in 17 patients (85%), which was suspected to be necrosis in the lesion. Conclusions: This retrospective analysis showed that pre-bronchoscopy gargling with water may contribute to the reduction of bronchoscopy-related infection.