Impact of Bronchoscopy Hang Time Extension

Abstract

Background: Flexible bronchoscopies are used to aid in the diagnosis and management of respiratory diseases, foreign body detection and removal, and visualization of the upper and central respiratory tract. Scopes are processed using a high-level disinfection process after patient use and then hung to prevent moisture accumulation in a specialized cabinet that circulates filtered air. There is little research regarding the appropriate hang time of a scope before needing to be reprocessed to avoid contamination of any type while the scope hangs in the closet. The Association for the Advancement of Medical Instrumentation states that the amount of time is not well defined. At our pediatric facility (260-bed Pediatric Hospital, Level 1 Trauma, Level IV NICU), we previously reprocessed our bronchoscopes after 7 days of hang time. In November of 2023 we changed our reprocessing time to every 14 days. We aim to determine if infection control risk increased via protein development representing microbial growth on flexible bronchoscopes, the impact on staffing time, and number of repairs secondary to this change.

Methods: An IRB-exempt prospective chart review and risk assessment was conducted before and after scope processing time was extended from 7 days to 14 from 5/1/2024- 3/31/2024. Protein scope swab records were analyzed for all scopes meeting the 7-day expiration date prior (5/1/2023-10/31/2023) and after extension to 14-day hang time (11/1/2023-3/31/2024). Scope repair records and equipment technician time to this process were analyzed.

Results: During the 7-day hangtime, 33 scopes were swabbed, and 26 scopes were swabbed after 14-day hangtime for any proteins. For all scopes, no protein swab resulted positive. The occurrence of broken/damaged scopes during processing was reduced from 9 scopes ($20,000 repair cost) to 4 scopes ($8,000 repair cost) pre and post change. Time savings for the RT equipment tech related to this work was reduced from 2.5 h/week to 1.25 h/week post implementation.

Conclusions: Increasing flexible respiratory bronchoscope hangtime from 7 to 14 days had no adverse protein test failure impact in our pediatric facility. Additionally, technician time savings and repair cost savings were reported. Further research must be done to determine the impact of longer scope hangtime in other environments and related to patient outcomes.