The lessons in bronchoscopy protection taught by the novel coronavirus are ones that should be permanently adopted.
So conclude Italian researchers in a review entitled, “The Role of Bronchoscopy in the Diagnosis and Management of Patients With SARS-CoV-2 Infection,” recently published in Diagnostics.
“It has become increasingly clear that bronchoscopy can be performed safely in all the scenarios in which it is clinically indicated,” write Dr. Davide Biondini and others from the University of Padova, in Padova, Italy. “Moreover, if protective equipment is correctly used, the rate of infection of the healthcare personnel reported was low.”
This current thinking, that bronchoscopy can be performed safely in all scenarios in which it is clinically indicated, stands in stark contrast to the earliest days of the pandemic when fear of infection essentially halted the procedure.
“We believe that bronchoscopy, with adequate protection and infection control, should no longer be postponed, and all the protection protocols for the procedure should become routine in the endoscopic suites from now on,” the authors write.
Many scientific societies, they note, have issued guidelines to standardize clinical practice in bronchoscopy, including recommendations to use single-use bronchoscopes.
In March 2020, the American Association for Bronchology and Interventional Pulmonology (AABIP) recommended that physicians not perform bronchoscopies on patients suspected or confirmed to have COVID-19. If bronchoscopy was warranted during COVID-19 testing or treatment, AABIP said “disposable bronchoscopes should be used first line when available.”
National and international task forces and societies added to the chorus advocating for single-use bronchoscopes when bronchoscopies needed to be done.
“Clearly, single-use flexible bronchoscopes are sterile, opened and used only for a single patient, avoiding the risk of any type of bronchoscope cross-contamination from one patient to the other, as well as the risk for the healthcare workers during transporting or reprocessing/sterilization,” the authors write in Diagnostics.
They cited a recent review published in Anaesthesia that examined 16 studies performed in endoscopy and intensive care units showing that the cost per use for a single-use flexible bronchoscope was slightly lower than for reusables. That gap increased when factoring in the potential costs of treatment of infection due to contaminated reusable scopes, according to the review.
Those researchers acknowledged a limitation of their study: The cost effectiveness of single-use bronchoscopes in endoscopy units is not comparable to an intensive care unit.
The Italian researchers say that more than 21 months since the first cases of the novel coronavirus appeared, we continue to learn to “cohabit with virus spread.”
“The time has come to move on and consider all the new protocols used in the bronchoscopic units as the daily routine from now on, in order to come back as close as possible to the number of procedures as in the pre-COVID19 era in all the interventional pneumology centers; indeed, it is unrealistic to continue the delay of certain procedures, even the elective ones,” the authors say.