Single-Use Flexible Bronchoscopy: The Ultimate Solution for Infection Control or a Compromise Under Cost and Environmental Pressure?
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In the Department of Respiratory and Critical Care Medicine, the flexible bronchoscope serves as a mirror that penetrates deep into a patient’s airways to diagnose and treat lung diseases, yet it also has the potential to become a vector for infection transmission. With technological advancements, a “dispose-after-use” single-use flexible bronchoscope (SUFB) is moving from the intensive care unit (ICU) into routine bronchoscopy suites, challenging the long-standing dominance of conventional reusable flexible bronchoscopes (RFBs). Is it the “ultimate solution” to infection risks, or merely a “stopgap measure” under cost and environmental pressures?
This article provides a detailed breakdown based on the latest academic review, Single-Use Flexible Bronchoscopy: Advances in Technology and Applications.
01 . Conventional Bronchoscopes Carry Infection Risks That Are Difficult to Eradicate
Conventional reusable bronchoscopes are classified as “semi-critical” medical devices, as they come into contact with mucous membranes and must undergo high-level disinfection after each use. However, complete sterilization (e.g., with autoclaving) would damage the equipment, making it unachievable.
Even so, reusable bronchoscopes have been linked to more infection outbreaks than any other medical device. This is largely attributed to human error and underreporting during the complex reprocessing workflow (pre-cleaning, leak testing, manual cleaning, high-level disinfection, rinsing, drying, and storage).
The literature cites a striking study:
An inspection of 24 bronchoscopes in clinical use at three hospitals found that every single one had residual contaminants after manual cleaning. Even after the full reprocessing procedure, 58% of the scopes still cultured positive for pathogens, including mold, E. coli/Shigella, and Stenotrophomonas maltophilia. Visual inspections revealed scratches, damaged components, residual fluid, oily/dark residues, and filamentous debris within the lumens.
These structural damages and residual fluids create a breeding ground for biofilm formation, which readily harbors multidrug-resistant “superbugs.” This reveals a harsh reality: under current reprocessing standards, RFBs carry an inherent and unavoidable risk of cross-infection.
02. Single-Use Bronchoscopes Offer Unique Value Across Multiple Clinical Scenarios
A single-use bronchoscope is a sterile, ready-to-use device designed for a single patient and disposed of after use. It typically consists of a disposable insertion tube and a reusable clean processor/display unit, offering advantages such as portability, no need for complex cleaning, and immediate availability.
Initially, SUFBs were used primarily in the ICU for intubation and percutaneous tracheostomy. However, their applications have since expanded significantly. According to the literature, SUFBs have demonstrated advantages in various scenarios:
➤ Mobility and Convenience:
Bedside procedures in emergency departments/wards, ICUs, and out-of-hospital emergency care.
➤ Specific Infection Control Scenarios:
Immunocompromised patients, patients with suspected prion disease.
➤ Practicality and Other Applications:
After-hours bronchoscopy, eliminating the need to schedule cleaning staff, as a bronchoscopy training tool, and in veterinary/large animal research.
03. Bench and Clinical Studies Confirm Comparable Performance to Conventional Scopes
This is the most pressing concern for clinicians. Early single-use scopes lagged behind reusable ones in ergonomics and performance, but technology has rapidly advanced in recent years.
Bench test results show performance varies by model
(Bench testing refers to objective measurements and comparisons of medical device performance indicators under standardized laboratory conditions. It does not involve patients but simulates clinical operations to quantify technical capabilities, providing objective, comparable data for clinical selection.)
A 2021–2022 study compared five leading SUFB models (working channels 2.8–3.0 mm) on the market at the time. The findings:
➤ Suction performance:
The Boston Scientific EXALT Model B demonstrated suction capability “substantially superior” to all other single-use scopes and even outperformed a reusable scope with a 3.2 mm channel, making it the preferred choice for managing hemoptysis, thick secretions, foreign bodies, and tumor ablation.
➤ Handling and ergonomics:
Different brands excelled in handle design, tip flexion/extension angles, and stability during instrument passage. For example, the Vathin scope offered the greatest tip range of motion. Operator gender and hand size also influenced preferences.
➤ Other features:
Some models, such as the Ambu aScope 5, feature left/right rotation of the insertion tube and have received approval for electrosurgical use.
Existing clinical data support efficacy and safety
To date, six clinical studies (involving 670 patients) have evaluated SUFB performance in bronchoscopy suites. These studies covered five different SUFB models and yielded encouraging results:
➤ Scope of procedures: 22% (149/670) of cases involved diagnostic or therapeutic procedures beyond bronchoalveolar lavage (BAL), including biopsy, brushing, transbronchial needle aspiration, cryobiopsy, ablation, and stent placement.
➤ Conversion rate: Only 3% (21/670) of cases required conversion to a conventional reusable bronchoscope for technical reasons.
➤ Technical limitations: 9% of cases reported technical limitations (e.g., image quality, suction, angulation, and accessibility), though the authors noted that many of these issues can also occur with RFBs.
➤ Operator satisfaction: In single-arm studies, 80–88% of operators gave the highest satisfaction rating (e.g., 5 out of 5); in controlled studies, SUFBs were considered comparable in performance to RFBs.
04. Comprehensive Cost Analysis Reveals Long-Term Benefits of Single-Use Bronchoscopes
Cost is a core factor for healthcare institutions considering a switch, but it requires a full accounting.
Cost-effectiveness analyses summarized in the literature show:
High-volume endoscopy centers (>1200–1500 procedures/year):
The per-procedure cost of conventional reusable bronchoscopes (approx. €78–150) is often lower than that of single-use scopes (approx. €220–232), because the high acquisition, cleaning, maintenance, and labor costs are diluted across a large number of cases.
Low-volume endoscopy centers (<300–350 procedures/year):
Single-use bronchoscopes often break even or become more cost-effective, as the fixed costs of reusable scopes cannot be spread over enough cases.
However, the above calculations do not account for infection-related costs.
A systematic review noted that the weighted average risk of infection or cross-contamination associated with reusable bronchoscopes is approximately 2.8%, compared to 0% for single-use scopes. When the diagnostic and treatment costs of infections are included, the true cost of reusable scopes rises significantly. For example, a UK analysis found that after factoring in a 2.8% infection risk, the per-procedure cost of reusable scopes jumped from ~£249 to £511, while the cost of single-use scopes remained stable at £220.
Additionally, single-use scopes save on cleaning personnel costs, repair expenses, microbiological monitoring, and maintenance of certified cleaning areas, while reducing case turnaround time, occupational exposure risk for healthcare workers, and contact with chemical disinfectants.
05. Environmental Impact Is a Core Challenge for Sustainability
Healthcare systems contribute approximately 4–5% of global greenhouse gas emissions, with medical devices accounting for 21%. The environmental burden of single-use medical devices cannot be ignored.
Current evidence is conflicting:
One life cycle assessment concluded that the environmental footprint of SUFBs is influenced by manufacturing materials, while that of RFBs is affected by cleaning consumables (detergents, disinfectants, water, personal protective equipment). Because cleaning practices vary widely across institutions, it is impossible to definitively state which system is overall more environmentally friendly. A waste audit of 278 endoscopic procedures estimated that a complete switch to single-use bronchoscopes would increase total clinical waste by up to 40%. A 2024 systematic review concluded that, from a purely environmental perspective, a well-managed, high-volume reusable system tends to have a lower carbon footprint and generate less waste.
Thus, no consensus exists regarding environmental impact. The literature calls for the development of recyclable methods for SUFB components and for multi-stakeholder assessments involving healthcare facilities, environmental experts, and health technology bodies to make more sustainable choices.
06. Conclusion and Future Outlook
The COVID-19 pandemic and growing awareness of endoscopy-related infections have jointly driven the development of single-use bronchoscopy technology. Current evidence indicates that SUFBs are non-inferior to conventional reusable bronchoscopes in routine bronchoscopy suite procedures (e.g., lavage, biopsy, brushing) in terms of efficacy and safety, while offering unique advantages in infection prevention, portability, immediate availability, and training.
Cost-effectiveness depends on a facility’s annual procedure volume, but the hidden costs of infection from reusable scopes must be factored into calculations. Environmental impact remains the greatest point of debate and challenge, requiring breakthroughs in material recyclability from the industry.
Although clinical adoption continues to grow, aside from an expert consensus issued by the Chinese Thoracic Society, most international respiratory societies have yet to issue formal guidelines on the use of SUFBs. In the future, more authoritative guidance, more environmentally friendly product designs, and longer-term clinical data will help healthcare institutions worldwide make more informed decisions in this “single-use versus reusable” transformation.
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