Bronchoscopy is an important diagnostic and therapeutic procedure for critically ill patients. But experts have raised caution flags around performing this vital procedure due to the raging COVID-19 pandemic.

An international panel of pulmonary and critical care experts is recommending that physicians use disposable single-use bronchoscopes “where possible … if timely and validated reprocessing of the bronchoscopes is not ensured.”

The process for device disinfection doesn’t need to be changed if timely and validated bronchoscope reprocessing is in place, the panel added – but the bronchoscope should be transported and sterilized separately from other patients.

This group of pulmonary and critical care experts released a new joint statement, “Performing Bronchoscopy in Times of the COVID-19 Pandemic: Practice Statement from an International Expert Panel,” in late April 2020 in Respiration: International Journal of Thoracic Medicine.

The recommendation to use single-use, or disposable, instruments for bronchoscopy mirrors the recommendations of the American Association for Bronchology and Interventional Pulmonology (AABIP). In a statement on March 19, AABIP recommended the use of disposable bronchoscopes if bronchoscopy was warranted on a suspected or confirmed COVID-19 patient.

COVID-19 first appeared in China in December 2019, and by May 5, 2020, had claimed 254,592 lives worldwide, according to the Johns Hopkins Coronavirus Resource Center. The center reported 70,110 U.S. deaths by that date.

“Bronchoscopy is an aerosol-generating procedure that leads to a pronounced formation of aerosols and thus poses a high risk of infection to proximate healthcare staff,” the statement reads.

Suspected or confirmed COVID-19 patients may still need a bronchoscopy despite the risks, according to the expert panel. Physicians may need to perform a bronchoscopy on a suspected COVID-19 case if nasopharyngeal smears return negative results for patients exhibiting multiple symptoms of COVID-19. And sometimes COVID-19 patients are in need of life-saving therapeutic interventions.

Approximately 500,000 bronchoscopies are performed annually under normal circumstances. While rare, there have been reported cases of device-related cross-contamination that were traced back to inadequately reprocessed bronchoscopes. Several instances have included antimicrobial-resistant organisms like P. aeruginosa.

Many experts also believe that instances of cross-contamination from bronchoscopes are underreported due to poor surveillance.

The panel of scientists provide detailed recommendations in the international statement about when and where bronchoscopy should be performed today. Safety measures for healthcare personnel include:

• Limited staff present for procedure
• Use disposable personal protective equipment
• Use general anesthesia with muscle relaxant to reduce aerosol production
• Disinfect the exam room (including with an air disinfection machine) after every procedure
• Practice strict hand hygiene prior to leaving exam area

More Resources for Bronchoscopy During the COVID-19 Pandemic

In a new, on-demand webinar, epidemiologist, Cori L. Ofstead offers critical information for healthcare personnel on the front lines of the pandemic. Registration for the webinar is free.

This video tutorial offers a brief demonstration of how to limit aerosolization during bronchoscopy and BAL.

Ambu stands ready to support the healthcare industry in this difficult time and are doing everything we can to ensure supply of our fourth-generation single-use bronchoscopes, which are used in more than 2,500 hospitals nationwide, along with our closed-loop bronchial sampling system. For more information, visit ambuusa.com.