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.