Safe Practice of Flexible Bronchoscopy for Non-COVID-19 Indications during the SARS-CoV-2 Pandemic

Flexible bronchoscopy is an aerosol-generating procedure (AGP), which increases the risk of transmission of SARS-CoV-2 infection. We aimed to find COVID-19 symptoms among healthcare workers (HCWs) involved in flexible bronchoscopies for non-COVID-19 indications during the SARS-CoV-2 pandemic.
The participants of this hospital-based single-center descriptive study were HCWs of our hospital involved in flexible bronchoscopies of patients with non-COVID-19 indications. These patients had no clinical features of COVID-19 and were tested negative for SARS-CoV-2 by the real-time polymerase chain reaction of nasopharyngeal and throat swabs before the procedure. The study outcome was the occurrence of COVID-19 in study participants after exposure to bronchoscopies.
Thirteen HCWs performed 81 bronchoscopies on 62 patients. Indications for bronchoscopies included malignancy (61.30%), suspected infections (19.35%), non-resolving pneumonia (6.45%), mucus plug removal (6.45%), central airway obstruction (4.84%), and hemoptysis (1.61%). The mean age of patients was 50.44 ± 15.00 years, and the majority was males (72.58%). Bronchoscopic procedures included 51 bronchoalveolar lavages, 32 endobronchial ultrasound- transbronchial needle aspiration (EBUS-TBNA), 26 endobronchial biopsies, 10 transbronchial lung biopsy (TBLB), 3 mucus plug removals, 2 conventional TBNA, and 2 radial EBUS-TBLB. Except for two HCWs who complained of transient throat irritation of non-infectious cause, none of the cases developed any clinical features suggestive of COVID-19.
A dedicated bronchoscopy protocol helps in minimizing the risk of transmission of SARS-CoV-2 infection among HCWs involved in flexible bronchoscopies for non-COVID-19 indications during the SARS-CoV-2 pandemic.