Potential for occupational exposures to pathogens during bronchoscopy procedures

Abstract

Bronchoscopy is classified as an aerosol-generating procedure, but it is unclear what drives the elevated infection risk observed among healthcare personnel performing the procedure. The objective of this study was to characterize pathways through which bronchoscopists may be exposed to infectious agents during bronchoscopy procedures. Aerosol number concentrations (0.2–1 µm aerodynamic diameter) were measured using a P-Trak Ultrafine Particle Counter 8525 and mass concentrations (<10 µm) were measured using a SidePak Personal Aerosol Monitor AM510 near the head of patients during bronchoscopy procedures. Procedure pathway, number of patient coughs, number of suctioning events, number of contacts with different surfaces by the pulmonologist, and the use and doffing of personal protective equipment were recorded by the investigator on a specially designed form. Any pulmonologist performing a bronchoscopy procedure was eligible to participate. A total of 18 procedures were observed. Mean particle number and mass concentrations were not elevated during procedures relative to those measured before or after the procedure, on average, but the concentrations were highly variable, exhibiting high levels periodically. Patients frequently coughed during procedures (median 65 coughs, range: 0–565 coughs), and suctioning was commonly performed (median 6.5 suctioning events, range: 0–42). In all procedures, pulmonologists contacted the patient (mean 22.3 contacts, range: 1–48), bronchoscope (mean 19.4 contacts, range: 1–46), and at least one environmental surface (mean 31.2 contacts, range: 3–62). In the majority of procedures, the participant contacted his or her body or personal protective equipment (PPE), with a mean of 17.3 contacts (range: 4–48). More often than not, the observed PPE doffing practices differed from those recommended. Bronchoscopy procedures were associated with short-term increased ultrafine or respirable aerosol concentrations, and there were opportunities for contact transmission.

Keywords:

• Aerosol-generating procedures
• bronchoscopy
• infection prevention
• contact patterns
• personal protective equipment

Acknowledgments

We would like to thank Dayana Maita and all of the pulmonology staff for assistance with scheduling observations and their willingness to participate in this study. We would also like to thank Susan Bleasdale for helpful comments on the manuscript.

Additional information

Funding

This work was funded by the Centers for Disease Control and Prevention through cooperative agreement U54CK000445-01. The funder had no role in this work. The authors have declared no conflicts of interest. These data will be available through UIC INDIGO within 6 months of publication or upon request.