•\ Storage and documentation are also an integral part of the reprocessing workfow.

•\ To minimize exposure, adequate packaging and proper pathways of contaminated equipment must be de ned. Hermetic boxes are considered to be a good option.

•\ Disposable bronchoscopes are recommended in con rmed COVID-19 patients with clear advantage on portability, post-procedural handling, and cross-contamination risk [9].

•\ Disinfection of the foor and surfaces of the bronchoscopy suite must be performed after each procedure using intermediate-level disinfectants with proven activity against enveloped viruses include 0.1% sodium hypochlorite, 62–71% ethanol, 0.5% hydrogen peroxide, and quaternary ammonium compounds [13–15].

Optimization ofCircuits

The security of health care workers and patients is a priority. De ning proper rules and circuits in the IP unit is crucial.

For health professionals:

•\ The allocation of human resources in IP unit should be reduced and priorities according to the outbreak evolution and hospital needs. The minimal number of staff required to ensure a correct operation must be de ned.

•\ It is essential that everyone is familiar and knows their speci c role. Train and maintain competency on effective hand hygiene and every aspect of PPE (theoretical, training and simulation sessions) is fundamental.

•\ All interactions with patients must include the same level of care. The staff should not reduce the level of awareness and protection, and the idea that patients suspected of COVID-19 should be handled in the same manner as con-rmed cases must be reinforced.

•\ The most experienced staff should be responsible for the procedure in SARS-CoV-2 positive patients, to reduce time and effectively

deal with possible complications. Other healthcare personnel, medical students and visitors should not be inside the unit or in the examination room before, during, or after the procedure. Training physicians may be present if they have signi cative awareness of the procedure that is going to be performed and if they had previous training and pro ciency in simulators and non-COVID-19 patients [16].

•\ All the exams must be performed in normal working hours and within an appropriate designated room that ful ls all the standards required for care, avoiding unnecessary increment of stress and risk for team and patient.

Personal Protective Equipment

IP procedures are considered to undertake the highest risk of exposure so full precautions must be taken, regarding all different possible types of transmission (contact, droplet, and airborne) [17]. Personnel involved in the reprocessing procedure must also wear protective equipment consisting of eye protection, respiratory mask FP2, long-sleeved gown, and double gloves [8].

The recommendations for the use of PPE are shown in Table 8.2.

Table 8.2  Personal protective equipment. (Adapted from F. Guedes et al., Recommendations for interventional pulmonology during COVID-19 outbreak: a consensus statement from the Portuguese Pulmonology Society)