Single-use Bronchoscope Research Articles

How green is my reusable bronchoscope?

IntroductionSingle-use bronchoscopes have replaced reusable ones in many institutions. This study aimed to evaluate the environmental and financial impacts of both strategies: reusable and single-use bronchoscopes. Material and methodsWe conducted a pragmatic study in a 21-bed polyvalent ICU, in Saint-Brieuc, Bretagne, France. The eco-audit consisted of estimating greenhouse gas (GHG) emissions, considering the life cycle of each strategy. Greenhouse gas (GHG) emissions related to construction, packaging, transport and waste elimination were compared between 2 devices: the reusable bronchoscope, a Pentax® FI-16RBS that was disinfected twice daily; and the single-use bronchoscope, the bronchoflex agile® from TSC. ResultsFor the reusable bronchoscope, GHG emissions were marginally impacted by the number of bronchoscopies performed (from 185 kg eq.CO2 per year to 192 kg eq.CO2 for 10 or 110 bronchoscopies per year). For the reusable device, GHG emissions directly depended on the number of bronchoscopies performed with 3.82 kg eq.CO2 emitted per bronchoscopy. The breakeven point for the reusable bronchoscope was estimated at 50 bronchoscopies in terms of GHG emissions and 96 bronchoscopies for financial considerations. ConclusionConsidering current practice in our ICU, reusable bronchoscopes have lower GHG emissions when used more than 50 times a year and a lower cost when used more than 96 times a year as compared with single-use bronchoscopes.

Systematic Review and Cost-Consequence Analysis of Ambu aScope 5 Broncho Compared with Reusable Flexible Bronchoscopes: Insights from Two US University Hospitals and an Academic Institution.

The aim of this study was to perform a systematic review, meta-analysis and cost-consequence analysis of the single-use bronchoscope, Ambu aScopeTM 5 Broncho, in relation to reusable flexible bronchoscopes (RFB) available within three high procedure volume university hospitals and academic institutions in the USA. The primary outcome was incremental cost and the secondary outcome was incremental cross-infection risk of use for both the single-use flexible bronchoscope (SUFB) and RFBs. Cost estimates included capital, repair, and reprocessing costs derived from a prospective observational micro-costing approach within three large university hospitals and academic institutions. All costs were valued in 2022 US dollars (USD). A meta-analysis based on literature covering cross-contamination and infection from 2010 to 2020 investigated cross-infection risk following bronchoscopy procedures with RFBs. Capital costs were discounted at 3% over 5-8 years. All parameters were evaluated using both univariate deterministic and probabilistic sensitivity analyses. In high-volume hospitals, RFBs were cost minimizing compared to SUFBs. Probabilistic sensitivity analysis showed that RFBs were cost saving in 88% of iterations. Univariate analyses illustrated sensitivity of the base-case result to the procedure volume. Data from sensitivity analyses suggest that the two interventions are cost neutral at a break-even point of 756 procedures per year or 46 procedures per bronchoscope per year. Assuming equivalent clinical performance, single-use flexible bronchoscopes are not cost minimizing when including the costs associated with cross-infection in high-volume US university hospitals and academic institutions. Overall, the benefits of conversion from RFBs to SUFBs are dependent on the annual procedure volume of individual hospitals, expected cross-infection risk, and purchase price of the aScope 5 Broncho.

2033. Use of Sterile, Single-Use Bronchoscopes Reduces Procedure-Associated Readmissions Rates and Eliminates Potential Device Cross-Contamination

Abstract Background Improper reprocessing of reusable bronchoscopes poses a serious patient safety risk. The risk of patient infection resulting from use of contaminated bronchoscopes has been reported to be 2.8%. By virtue of being sterile, SFB eliminates device-related infection risk, subsequent readmission rates, and associated costs. Readmissions following bronchoscopy may occur for many reasons, but most frequently are due to infection, bleeding, or pain. These infections are preventable and can be eliminated with the use of a sterile, single-use bronchoscope when the device is used according to the manufacturer’s instructions for use. Methods Bronchoscopies with SFB and RFB were identified along with their corresponding readmission information in the Premier Healthcare Database from 2016- 2019. A logistic regression analysis was conducted with 30-day readmission as the dependent variable. Independent variables included use of a RFB, gender, race, age, payer, and discharge status. For the inpatient setting, the 3M™ APR DRG Severity of Illness classification was included as an independent variable. 30 Day Readmissions Results A total of 14,228 procedures were identified, of which 1,795 used SFB and 12,433 used a RFB. In the inpatient setting, the RFB group was ∼2.5 times more likely to be readmitted within 30 days compared to the SFB group (OR=2.5, p< 0.01), controlling for patient demographics and risk. In the outpatient setting, the RFB group was ∼1.5 times more likely to be readmitted than the SFB group (OR=1.5, p >0.05). Across all settings, the RFB group was ∼2.3 times more likely to be readmitted than the SFB group (OR=2.3, p< 0.01). The inability to fully risk-adjust in the outpatient setting may have been a factor in the smaller OR and lack of statistical significance; this limitation will be addressed with further analysis that includes an outpatient severity of illness classification variable. Conclusion Patients undergoing bronchoscopy typically have significant comorbidities which increase their risk for the development of potential device-related infections. To reduce these risks, the use of a sterile SFB should be considered to eliminate reprocessing failures, improve overall operational efficiency, and reduce potential acquisition of healthcare-associated infections. Disclosures John H. Garrett, PhD, MSN, MPH, MBA, FNP-BC, FNAP, FSHEA, FIDSA, Aerobiotix: Advisor/Consultant|Ambu: Advisor/Consultant|American Academy of Nurse Practitioners: Honoraria|Clorox Pro: Advisor/Consultant.

"Operator Perception of The Performance of Multiple Single-Use Bronchoscopes Compared to Standard Re-Usable Bronchoscope"

Single-use bronchoscopes have increased in popularity as concern for cross-contamination has increased. However, direct comparisons of the performance of these bronchoscopes to traditional re-usable bronchoscopes has been limited. In this study, we compare operator perception of re-usable and single-use bronchoscope performance in an ex-vivo model highlighting maneuverability, suction capability, and imaging processing.

Performance of a new single-use bronchoscope versus a marketed single-use comparator: a bench study

BackgroundSingle-use flexible bronchoscopes eliminate cross contamination from reusable bronchoscopes and are cost-effective in a number of clinical settings. The present bench study aimed to compare the performance of a new single-use bronchoscope (Boston Scientific EXALT Model B) to a marketed single-use comparator (Ambu aScope 4), each in slim, regular and large diameters.MethodsThree bronchoscopy tasks were performed: water suction and visualization, “mucus” mass (synthetic mucoid mixture) suctioned in 30 s, and “mucus” plug (thicker mucoid mixture) suction. Suction ability, task completion times, and subjective ratings of visualization and overall performance on a scale of one to 10 (best) were compared. All bronchoscopy tasks were completed by 15 physicians representing diversity in specialization including pulmonary, interventional pulmonary, critical care, anesthesia, and thoracic surgery. Each physician utilized the six bronchoscope versions with block randomization by bronchoscope and task.ResultsAspirated mean mass of “mucus” using EXALT Model B Regular was comparable to that for an aScope 4 Large (41.8 ± 8.3 g vs. 41.5 ± 5.7 g respectively, p = 0.914). In comparisons of scopes with the same outer diameter, the aspirated mean mass by weight of water and “mucus” was significantly greater for EXALT Model B than for aScope 4 (p < 0.001 for all three diameters). Mean ratings for visualization attributes were significantly better for EXALT Model B compared to aScope 4 (p-value range 0.001−0.029).ConclusionA new single-use bronchoscope provided strong suction capability and visualization compared to same-diameter marketed single-use comparators in a bench model simulation.

Evaluation of a new developed disposable and portable bronchoscopy system

BackgroundBronchoscopy is critical in the treatment of patients with coronavirus disease (COVID-19), and its use is associated with the challenges of stringent sterilization and virus transmission risk. We developed a disposable and portable bronchoscope (YunSendo-R) and compared its safety and function with those of current reusable and single-use bronchoscopes using an animal model.MethodsWe compared the YunSendo-R system with a commercially available reusable bronchoscope (Olympus, BF-H290) and single-use bronchoscope (Ambu, Ambu® aScope3™). Eight physicians used the three types of bronchoscopes to operate on Guangxi Bama mini pigs. Each operator performed bronchoscopy and completed a 10-point Likert scale questionnaire for evaluating visual ability and manoeuvrability. Operation time and scores were collected.ResultsOperation time had no significant differences among the three bronchoscopes. In visual ability, the YunSendo-R bronchoscope showed superior performance to the Ambu bronchoscope in image clarity, colour contrast, and illumination (P < 0.05) and no significant difference in performance compared with the Olympus bronchoscope (P > 0.05). The YunSendo-R bronchoscope had similar manoeuvrability to the Olympus bronchoscope and better scope tip flexibility than the Ambu bronchoscope (P > 0.05). No relevant complications were reported.ConclusionWe have developed a new bronchoscopy system with the advantages of disposability and portability, which was effective and safe in an animal model. It has better visual ability than the Ambu bronchoscope and similar visual ability and manoeuvrability to the Olympus bronchoscope. The YunSendo-R bronchoscope is a promising device for clinical practice, especially in reusable-endoscope-transmitted infectious diseases such as COVID-19.

Single-use products in endoscopy-from consumables to single-use scopes

Wie in diversen Fallberichten und prospektiven Studien beschrieben stellen flexible Endoskopien einen potenziellen Risikofaktor für klinisch relevante Infektionen dar. Bei den Übertragungswegen sind dabei endogene Infektionen, ausgelöst durch eine Verschleppung der körpereigenen Mikroorganismen des jeweiligen Patienten, von exogenen Infektionen, die durch eine Übertragung von kontaminiertem Material oder Endoskopen entstehen, zu unterscheiden. Um das Problem der steigenden Zahl bekannter, exogener Infektionen zu minimieren, wurden von der Industrie Einmalendoskope entwickelt und für den klinischen Einsatz zertifiziert. Einmalbronchoskope sind bereits seit Jahren Bestandteil der klinische Routineversorgung, Einmalduodenoskope wurden erst kürzlich zugelassen. Die Nutzung von Einmalendoskopen stellt vordergründig eine finanzielle Mehrbelastung des Gesundheitssystems dar. Neben den reinen Sachkosten der Einmalendoskope sind aber insbesondere auch die vermeidbaren Kosten klinische relevanter Infektionen, wie verlängerter Krankenhausaufenthalt, intensivmedizinische Behandlung und Folgeeingriffe, in der Gesamtkalkulation zu berücksichtigen. Unabhängig von betriebs- und volkswirtschaftlichen Überlegungen steht die Patientensicherheit im Zentrum pflegerischen und ärztlichen Handelns.

Single-Use or Disposable Flexible Bronchoscopy in Advanced Bronchoscopy Procedures: Experience in a Quaternary Referral Centre.

The development of single-use flexible or disposable bronchoscopes (SUFBs) has accelerated in recent years, with the reduced risk of infectious transmission and reduced need for endoscopy staffing particularly advantageous in the COVID-19 pandemic era. The objective of this study was to assess the performance of a novel single-use bronchoscope in an academic quaternary referral centre with on-site interventional pulmonology programme. With ethical approval in a quaternary referral centre, we prospectively collected data on sequential bronchoscopy procedures using The Surgical Company Broncoflex© range of SUFBs. Data collected included demographic, procedural, scope performance, user satisfaction, and complication parameters in a tertiary bronchoscopy service. 139 procedures were performed by five pulmonology faculty from January to July 2021. The majority were carried out for infection (45%) and malignancy (32%). Most were performed in the endoscopy suite and 8% were COVID positive or suspected. Most procedures reported the highest score in satisfaction (85%) with technical limitations reported in 15% (predominately related to scope suction or inadequate image quality) reverting to a reusable scope in 2.8 %. In our subset of patients in a bronchoscopy unit, SUFBs are safe, and both routine and advanced bronchoscopy procedures can be performed with high satisfaction reported.

Current status and cost reduction study of single-use bronchoscope in the operating room

Current status and cost reduction study of single-use bronchoscope in the operating room

Indications and Recommendations for Tracheostomy in Trauma Population With COVID-19 Infection: A Review of the Literature.

This review explores the current body of evidence pertaining to tracheostomy placement in COVID-19 seropositive patients and summarizes the research by tracheostomy indications, timing, and procedure. Literature review was performed in accordance with the 2020 PRISMA guidelines and includes 12 papers discussing protocols for adult patients seropositive for COVID-19. The studies demonstrated high mortality rates after tracheostomy, especially in geriatric patients, and suggested a multifactorial determination of whether to perform a tracheostomy. There was inconclusive data regarding wait time between testing seropositive, tracheostomy, and weaning off of ventilation. COVID-19 generally reaches highest infectivity between days 9 and 10; furthermore, high early mortality rates seen in COVID-19 may confound mortality implicated by tracheostomy placement. Due to the aerosol-generating nature of tracheostomy placement, management and maintenance, techniques, equipment, and personnel should be carefully considered and altered for COVID-19 patients. With surgical tracheostomy, literature suggested decreased usage of electrocautery; with percutaneous tracheostomy, single-use bronchoscope should be used. The nonemergent exchange of tracheostomy should be done only after the patient tested negative for COVID-19. Placement of tracheostomy should only be considered in COVID-19 patients who are no longer transmissible, with rigorous attention to safety precautions. Understanding procedures for airway maintenance in a respiratory disease like COVID-19 is imperative, especially due to current shortages in ventilators and PPE. However, because of a lack of available data and its likelihood of change as more data emerges, we lack complete guidelines for tracheostomy placement in COVID-19 seropositive patients, and those existing will likely evolve with the disease.

Bronchoscopist's perception of the quality of the single-use bronchoscope (Ambu aScope4\u2122) in selected bronchoscopies: a multicenter study in 21 Spanish pulmonology services

BackgroundThe disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist's perception of its quality has not been evaluated.MethodsTo evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of central tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis.ResultsThe most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 min. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 94.9% and the bronchoscopist was satisfied in 96.6% of the bronchoscopies. They highlighted the portability and immediacy of the aScope4TM to start the procedure in 99.3%, the possibility of taking and storing images in 99.3%. The CUSUM analysis showed average scores > 70/100 from the first procedure and from the 9th procedure more than 80% of the scores exceeded the 80/100 score.ConclusionsThe aScope4™ scored well for ease of use, imaging, and aspiration. We found a learning curve with excellent scores from the 9th procedure. Bronchoscopists highlighted its portability, immediacy of use and the possibility of taking and storing images.

Operator Perception of a Single-Use Flexible Bronchoscope: Comparison With Current Standard Bronchoscopes.

Single-use flexible bronchoscopes have gained popularity in recent years for various advantages over the traditional reusable bronchoscope. There are several commercially available disposable bronchoscopes; however, all have limitations compared to reusable bronchoscopes. The Vathin H-SteriScope is a single-use flexible bronchoscope that may have overcome some of these limitations. We designed a survey to evaluate the performance of this new single-use bronchoscope on a bronchoscopy model with operators who are familiar with current single-use and reusable bronchoscopes. The operators were asked to rank overall assessment, scope quality, handling, maneuverability, tool interaction, and image quality of the H-SteriScope on a scale of 0-100. These operators were then asked to rank their current single-use and reusable bronchoscopes with the same scale. The results were evaluated to determine the operator perception of the H-SteriScope. The H-SteriScope and current reusable bronchoscopes were perceived to have significant differences compared with currently available single-use bronchoscopes in overall assessment of the scope, scope quality, handling, maneuverability, tool interaction, and image quality (P < .001). The H-SteriScope was perceived to have similar maneuverability as the reusable bronchoscope (P = .86). There were no differences among the H-SteriScope (P = .88), the current single-use bronchoscope (P = .84), and the current reusable bronchoscope (P = .89) between the training and nontraining interventional pulmonology subgroups. In terms of operator perception, the H-SteriScope appears to have similar maneuverability as the reusable bronchoscope. Both the H-SteriScope and the reusable bronchoscopes performed better in all measured sectors than the current single-use bronchoscope. Additional studies are required to evaluate the practicality, safety, and cost efficiency of the H-SteriScope in clinical practice.

Experience with a Single-Use Bronchoscope in the Respiratory Medicine Department

Experience with a Single-Use Bronchoscope in the Respiratory Medicine Department

Cost Comparison of Single-Use Versus Reusable Bronchoscopes Used for Percutaneous Dilatational Tracheostomy.

BackgroundBoth single-use and reusable bronchoscopes are suitable for percutaneous dilatational tracheostomy (PDT) to visualise the trachea during the insertion process. To determine the least costly option, the price of single-use bronchoscopes must be weighed against the estimated average cost of a bronchoscopy with reusable equipment. In the latter case, the acquisition cost must be spread over the equipment’s useful life and other relevant costs, such as reprocessing and repair, must be included.ObjectiveThis study aimed to calculate the cost of using single-use or reusable bronchoscopes per PDT procedure.MethodsA systematic literature search was conducted to identify studies comparing the costs of reusable and single-use bronchoscopes for PDT. Inclusion criteria were articles assessing the cost of single-use or reusable bronchoscopes, and where costs were divided into acquisition, reprocessing, and repair costs. A questionnaire regarding repair rates and costs for reusable bronchoscopes was sent to 366 hospitals in the US, UK, and Germany to supplement the identified literature.ResultsEleven studies met the inclusion criteria. Ninety-nine completed responses were received, of which 31 hospitals used reusable equipment for PDT. Literature research revealed an average acquisition cost of $US135 (SD 152) and reprocessing cost of $US123 (SD 128). Additionally, a combination of data from the literature and the questionnaires gave a repair cost per use of $US148 (SD 242), resulting in a total average cost of $US406 for reusable bronchoscopes and $US249 (SD 36) for single-use bronchoscopes per PDT procedure. Thus, the incremental cost per use of a reusable bronchoscope compared with a single-use bronchoscope was $US157.ConclusionsWe conclude that significant savings can be made by using single-use bronchoscopes to guide PDT in preference to reusable bronchoscopes. Results depend on hospital setting, the reprocessing procedures, annual bronchoscope procedures, individual repair cost, and repair rates.Electronic supplementary materialThe online version of this article (10.1007/s41669-018-0091-2) contains supplementary material, which is available to authorized users.

Comparative Study on Environmental Impacts of Reusable and Single-Use Bronchoscopes

The introduction of single-use alternatives has stressed the need for environmental comparisons between reusable and single-use devises in the healthcare sector. Discarding of single-use devices intuitively causes concern among staff in hospitals, other users and people with environmental concerns as to whether the single use is environmentally friendly. This study aims to compare carbon dioxide (CO2)-equivalent emissions and resource consumption from a single-use bronchoscope (Ambu® aScopeTM 4) to a reusable flexible bronchoscope. The comparison is made using a simplified life-cycle-assessment methodology. The analysis shows that the materials used for the cleaning operations of the reusable scopes are a key factor affecting the impact factors assessed; energy consumption, emission of CO2-equivalent and consumption of scarce resources. Initially, it is assumed that each reusable scope is cleaned using one set of personal protective equipment (PPE) per cleaning operation, but since cleaning practice may vary the consequence of cleaning more scopes with one set of PPE is also assessed. Using one set of protective wear per operation and the materials for cleaning and disinfection determine that reusable scopes have comparable or higher material and energy consumption as well as higher emissions of CO2-equivalents and values of resource consumption. Cleaning two or more reusable scopes per set of PPE makes the impacts fairly comparable. Other aspects that may impact the results are also assessed, including energy consumption for washing and drying units, differences in use of PPE and differences in the disposal of PPE or single-use scopes. As the three assessed parameters are highly dependent on cleaning procedures and the use of protective equipment, it cannot be concluded from these results which type of bronchoscope affects the environmental factors investigated here the most.