Bronchoscopy safety precautions for diagnosing COVID-19 associated pulmonary aspergillosis - a simulation study.

Koehler, Philipp; Cornely, Oliver A; Kochanek, Matthias

OBJECTIVES With the outbreak of coronavirus disease 2019 (COVID-19), clinicians have used personal protective equipment to avoid transmission of severe acute respiratory syndrome coronavirus 2. However they still face occupational risk of infection, when treating COVID-19 patients. This may be highest during invasive diagnostic procedures releasing aerosols and droplets. Thereby the use of diagnostic procedures for Covid-19 associated aspergillosis may be delayed or impeded, as use of bronchoscopy has been discouraged. This leads to avoidance of a crucial procedure for diagnosing invasive aspergillosis. We intent to visualize aerosol and droplet spread and surface contamination during bronchoscopy and address which measures can avoid exposure of health care workers. METHODS We created a simulation model to visualize aerosol and droplet generation as well as surface contamination by nebulizing fluorescent solution detected by using ultraviolet light and slow motion capture. We repurposed covers for ultrasound transducers or endoscopic cameras to prevent surface and ambient air contamination. RESULTS In our bronchoscopy simulation model, we noticed extensive aerosol generation, droplet spread and surface contamination. Exposure of health-care workers and contamination of surfaces can be efficiently reduced by repurposing covers for ultrasound transducers or endoscopic cameras to seal the tube opening during bronchoscopy in mechanically ventilated patients. CONCLUSION Adequate personal protective equipment and safety strategies allow to minimize contamination during bronchoscopy in mechanically ventilated COVID-19 patients.