hospital

Bronchoscopy Applications

Limiting Aerosolization in Pediatric Bronchoscopy

AABIP recommends physicians use disposable, or single-use, bronchoscopes if bronchoscopy is warranted during the current crisis, which has killed more than 80,000 patients in the U.S.

Using disposable, translucent drapes to create a tent around a patient is one way to limit the threat of disease transmission from aerosolization during pediatric microlaryngoscopy and bronchoscopy.

That’s according to input from pediatric otolaryngologists, anesthesiologists, occupational medicine specialists, nursing staff, and medical engineers in a new research paper. The input is significant because of the risks to healthcare workers on the frontlines of the battle against COVID-19.

Bronchoscopy is an aerosol-generating procedure, and the novel coronavirus is spread through droplets produced when an infected person coughs or sneezes.

The paper, “Pediatric laryngoscopy and bronchoscopy during the COVID-19 pandemic: A four-center collaborative protocol to improve safety with perioperative management strategies and creation of a surgical tent with disposable drapes,” outlines several other safety measures that may be of use when the current COVID-19 crisis wanes. The International Journal of Pediatric Otorhinolaryngology published the paper in April 2020.

Creating a surgical tent using disposable drapes is a relatively simple technique to protect operating room personnel, according to the authors.

“The few additional resources that are required are generally accessible in any operating room or institution," they write. "This technique may prevent aerosolization of other pathogens in the future.”

To create the disposable drape tent, healthcare workers should:

  • Rotate the bed so the surgeon is standing at the head
  • Cover the patient’s eyes with water-tight adhesive coverings to allow for adequate washing of patient face after the procedure
  • Secure an ultrafiltration smoke evacuator to the patient’s chest, facing the patient’s head to filter viral particles during the procedure (this does not replace need for normal surgical suction)
  • Place an ether screen over the patient at chest level and secure to an OR table
  • Place clear, impermeable surgical drape over the patient’s head and body, suspended by ether screens (the bronchoscopy table should be under the same drape)

The authors do not recommend fully covering the patient in a drape. The drape, after all, needs to be easily removed and disposed of after the procedure. Aerosol particles should be contained within the drape at disposal.

Typically, about 500,000 bronchoscopies are performed in the U.S. annually. The American Association for Bronchology and Interventional Pulmonology (AABIP), however, has advised against bronchoscopy on suspected or confirmed COVID-19 patients. AABIP, in its March advisory, suggested other diagnostic measures such as nasopharyngeal and oropharyngeal swabs for collecting upper respiratory samples. For intubated patients, tracheal aspirates and non-bronchoscopic alveolar lavage may also be used.

AABIP recommends physicians use disposable, or single-use, bronchoscopes if bronchoscopy is warranted during the current crisis, which has killed more than 80,000 patients in the U.S.

The first cases of COVID-19 transmission to healthcare providers were reported as early as January.

Pulmonologists will be concerned about the risks of infection transmission from aerosolization during bronchoscopy long after the current COVID-19 pandemic. And some COVID-19-related precautions and adaptations may prove to be useful when bronchoscopy becomes a routine diagnostic and therapeutic procedure once again.

Patients should also be tested prior to a procedure, according to the paper. But testing cannot be a fail-safe, the authors write.

“Currently, there is variability across institutions with respect to access to testing, duration of testing, and reliability of results including false negative rates that at some institutions may be as high as 30–40 percent,” according to the paper.

More Infection Prevention Articles
Endoscope-Related Infection: A Look to the Future
Prevention Strategies
Exogenous infections relating to contaminated endoscopes have been historically difficult to quantify. A recent systematic review offers a look at potential solutions to reducing the risk of patient infection from cross-contamination.
PPE in Reprocessing: Vital for Safety and Eliminating Endoscope Contaminants
Prevention Challenges
Endoscope reprocessing involves a complicated series of between 50 and 100 steps depending on the device instructions for use and society guidelines adopted by the institution. Among the dozens of steps needed are several PPE changes to protect the integrity of the cleaning process.
More From Single-Use Endoscopy

Endoscopy Tech

A new system enables urologists to perform various endoscopic procedures with nothing more than a scope and their smartphone.

Challenges in device reprocessing are related to the lack of connection that hospital administrators and the public at large make between the resources given to our teams and the ultimate quality of surgical instruments available for every procedure.

Preventing Infection

Bigger hospitals typically offer more complex services, putting added strain on reprocessing departments — and the quality of reprocessing depends on the resources made available to the teams that do that work.

Experts agree that correct ergonomics is a learned behavior that must be practiced.

Performing Procedures

Otolaryngologists from around the world acknowledge that aches and pains are common in their profession and that they have received little training in proper ergonomics along the way.