Bronchoscopy Procedures

Q: Could you clarify whether bronchoscopy procedures should be performed in a negative pressure room or positive pressure? It’s seems as though many folks are doing them bedside and using emergent need as a justification to do so. I seem to recall that the AIA guidelines to indicate a negative pressure room.

A: Here is how the FGI Guidelines call ventilation requirements for Bronchoscopy:

2014 FGI:                   negative           12 ach

2010 FGI:                   negative           12 ach

2006 FGI/AIA:           negative           12 ach

2001 AIA:                   negative           12 ach

1996-97 AIA:             negative           12 ach

So… it is obvious bronchoscopy needs to be done in a room that is negative and has 12 air changes per hour. The typical patient room does not have that level of ventilation.

While FGI Guidelines are in fact guidelines and not standards or regulations, authorities such as accreditation organizations and state departments of health can adopt them as a requirement. Some accreditation organizations may permit a bronchoscopy outside of a properly ventilated room if it was a true emergency, but what constitutes an emergency? That’s beyond my capabilities and perhaps yours. Ultimately, that decision will be reviewed and assessed by the accreditation organization. They will judge if the emergency procedure is just or not.

I recently attended a conference where a representative from the Joint Commission engineering department stated that Joint Commission will allow bedside bronchoscopies provided the organization has a written, documented policy permitting them, and the organization has conducted a risk assessment to determine that the patient is TB free. The risk assessment would have to be documented as well.

Make sure your Infection Control practitioner is part of the discussion to determine proper utilization of the procedure. I would also suggest you contact your state agency who surveys you on behalf of CMS and ask if they would permit an emergency bronchoscopy procedure outside of a properly ventilated room.

Bronchoscopy Procedure Rooms

Q: Are Bronchoscopy procedures to be performed in negative pressure rooms under all circumstances, or can they be performed in OR suites? Does the negative pressure rule only apply to new construction, or does it apply universally to all facilities old and new?

A: According to the 2010 FGI Guidelines for Design and Construction of Health Care Facilities, ventilation requirements for a Bronchoscopy procedure room requires negative air pressure relationship to the surrounding area, and a minimum of 2 outdoor air exchanges per hour and a total of 12 air exchanges per hour. This ventilation requirement must be met regardless where the Bronchoscopy procedure is conducted, which includes the operating rooms. So, to answer your first question: Yes, this requirement applies to all circumstances.

The ventilation requirements found in the 2010 FGI guidelines applies to new construction or renovated areas. It is not a standard, and it does not apply to existing conditions. However, the ventilation requirements for Bronchoscopy procedures have been consistent since the 1996-1997 edition of the guidelines, and perhaps even before that (I only have records back to the 1996-1997 edition). So, if you have constructed or renovated the Bronchoscopy procedure room since 1996-1997, then these ventilation requirements must be complied with.

Some authorities will allow deviance from the FGI guidelines as they are guidelines and not standards. So, if you have extenuating circumstances that requires you to deviate from the FGI guidelines, then contact your AHJ to determine what their expectations are.