Authors: (including presenting author): :
Chow CHA(1), Lo WPJ(1)
Affiliation: :
(1) The Intensive care unit, Pamela Youde Nethersole Eastern Hospital
Keyword 1: :
Bronschoscopy
Keyword 2: :
Disposable bronchoscopy
Keyword 3: :
Reuse of disposable bronchoscopy
Keyword 4: :
Safety of reuse bronchoscopy
Introduction: :
The COVID-19 pandemic led to a marked increase in the use of single-use disposable flexible bronchoscopes (SUFBs), driven by concerns over infection transmission, urgent service demands, and limitations in reprocessing capacity. While SUFBs offer logistical convenience and theoretical advantages in infection control, their widespread adoption has raised important questions regarding microbiological safety after use, cost-effectiveness, and environmental considerations.
Objectives: :
This review aimed to examine current evidence on microbial contamination associated with SUFBs after clinical use and short-term storage, evaluate safety, cost, and environmental considerations compared with reusable bronchoscopes, analyze local bronchoscope utilization patterns, and identify potential recommendations and areas for improvement based on the findings of the review.
Methodology: :
A focused review of the literature was conducted, including prospective microbiological studies and systematic and narrative reviews comparing disposable and reusable bronchoscopes. In parallel, data on bronchoscope utilization between January and June within the single unit were retrospectively examined, including device selection patterns and whether any disposable bronchoscopes were reused.
Result & Outcome: :
Published studies demonstrate that SUFBs may become contaminated with clinically significant microorganisms immediately after use (time zero), with microbial persistence and proliferation during short-term storage (24-48hours) in up to 35% of cases being investigated, even following basic cleaning. High-risk pathogens associated with ventilator-associated pneumonia, including Pseudomonas aeruginosa and Klebsiella pneumoniae, have been identified, highlighting potential patient safety concerns if post-use handling is suboptimal. In the unit’s utilization review, 91 bronchoscopic procedures were performed, with SUFBs used in 72.5% of cases and reusable bronchoscopes in 27.5%. Among these patients, 4 (4.4%) required a repeat bronchoscopy. However, since high level disinfection is impossible for disposable bronchoscopes, patients may be exposed to increased risk of contamination and infection transmission. It is concluded that increased use of disposable bronchoscopes warrants critical re-evaluation. Although SUFBs reduce cross patient contamination, current evidence shows they still carry microbiological risks if it is repeatedly used. If a patient acquires nosocomial pneumonia, this may lead to prolonged hospitalization, raise healthcare costs, and increase environmental contamination or transmission. To mitigate these risks, disposable bronchoscopes should be discarded immediately after use. Reusable bronchoscopes undergoing high level sterilization should remain the standard for routine and low infection risk cases. Disposable devices should be reserved for selected high infection risk or urgent situations to enhance patient safety, optimize resource utilization, and support sustainable practice.
