ICUs shifting to single-use bronchoscopes for bedside procedures

Bronchoscopy has become an essential tool in the intensive care unit (ICU) for airway management of patients suffering from respiratory illness and blockages, including those undergoing treatment¹ for acute COVID-19. Bronchoscopes are versatile, multi-purpose devices, supporting real-time imaging of the passages between the vocal cords and bronchi, removal of foreign bodies, suctioning of secretions, and collection of samples for diagnostic and therapeutic purposes.

Among essential endoscopy products for the ICU, bronchoscopes fall into two distinct categories: reusable and disposable. Reusables must be disinfected and reprocessed before being redeployed for the next patient. By contrast, each disposable bronchoscope is deployed for a single use with a single patient and then discarded.

Due to their lower risk of contamination, disposable bronchoscopes are increasingly recommended for, and adopted by, health care organizations that prioritize patient and staff protection.

Patients on a ventilator in the ICU who are undergoing treatment for COVID-19 may receive bedside bronchoscopy and endotracheal intubation. The bronchoscope and its controller are brought into the hospital room on a cart, so that the flexible end of the device can be threaded through the endotracheal tube.

In 2015, an FDA Safety Communication³ raised concerns about infections associated with reprocessed flexible bronchoscopes, including them among a subset of devices that “pose a greater likelihood of microbial transmission and represent a high risk of infection if they are not adequately reprocessed.” The statement described real-world challenges in adhering to meticulous multi-step reprocessing and noted that additional risk arises when reusables remain in service after multiple repairs or development of hairline cracks and crevices that can harbor contaminants.

Health care personnel face risk of exposure to infectious agents during reprocessing and, even when proper handling guidelines are followed during reprocessing, reusable bronchoscopes have been found⁴ to raise patient risk as well. Researchers who analyzed 16 studies of flexible bronchoscopy in the ICU and respiratory units concluded that “The results revealed an overall 2.8% infection risk to the patient which considerably decreased the cost-effectiveness” of reusables.

Single use endoscopy serves as an important alternative to reusables. Due to the heightened infection risk associated with reusables, the American Association for Bronchology and Interventional Pulmonology (AABIP) has issued guidance⁵ that “disposable bronchoscopes should be used first line when available” for suspected or confirmed COVID-19 patients who need bronchoscopy. An international panel of experts issued the same recommendation in the journal Respiration⁶.

In a letter to the editor⁷ of the Journal of Bronchology and Interventional Pulmonology, doctors from Cork University Hospital in Ireland said, “we agree with the AABIP endorsement of single-use bronchoscopes in patients with or suspected of COVID-19 infection.” Beyond the net economic benefit⁸ of disposable bronchoscopes, they noted that, “in the current era of COVID-19 pandemic, there are a number of reasons why single-use bronchoscopes have advantages.” For example, disposable bronchoscopes remain available when healthcare workers themselves have gotten infected and are unavailable to clean bronchoscopes. Disposables are likewise unimpacted during shortages of personal protective equipment (PPE) necessary for cleaning reusables. “Single-use bronchoscopes have also advantages in ‘out of hours’ bronchoscopy and bronchoscopy outside of the endoscopy or bronchoscopy unit,” they noted.

As ICUs choose to transition to disposable bronchoscopes, departmental risk and costs are reduced by minimizing labor requirements for reprocessing, curbing need for training and compliance tracking, and reducing scheduling conflict around patient procedures. Potential for spread of infection and contamination drops through use of a clean, single use disposable scope for each patient.