The Effectiveness of Immersion Disinfection for Flexible Fiberoptic Laryngoscopes

Single-use versus reusable rhinolaryngoscopes for inpatient otorhinolaryngology consults: Resident and patient experience

Objectives

Single-use rhinolaryngoscopes were brought to market in 2019 as an alternative to traditional reusable scopes and have garnered interest across settings given portability and potential cost advantages. While single-use was previously evaluated compared to traditional devices, the overall impact to the consult experience for both users and patients has not been captured.

Methods

Eighteen residents performed consults with both single-use and reusable rhinolaryngoscope systems on alternating weeks. A five-question cumulative survey administered across three assessment points over a 12-week period using a five-point rating system to rate favorability. Residents and patients also completed four-point scale surveys following procedure(s) to capture the consult experience. Statistical analyses were performed to measure significance differences between survey responses between the two systems.

Results

Single-use rhinolaryngoscopes received higher overall ratings compared with reusables across each metric captured including overall consult time (4.3 vs. 2.2, p < .001), multiscope consults (4.4 vs. 3.1, p < .001), patient communication (4.6 vs. 2.1, p < .001), teaching opportunities (4.6 vs. 2.1, p < .001), and overall ease of use (4.7 vs. 2.6, p < .001). Residents rated single-use higher than reusable after each procedure in terms of ease of use (1.07 vs. 2.68, p < .001) and visual clarity (1.27 vs. 1.89, p = .003), while patients rated single-use higher for understanding of illness (3.9 vs. 3.1, p < .001) and understanding of treatment rationale (3.9 vs. 3.1, p < .001).

Conclusion

Resident and patient experience feedback favored single-use rhinolaryngoscopes compared to reusable scope technology across multiple surveyed measurables. Single-use rhinolaryngoscopes provide a viable tool for otorhinolaryngologist and other clinicians to perform rhinolaryngoscopy consults.

Level of Evidence

4.

The Effectiveness of Ultraviolet Smart D60 in Reducing Contamination of Flexible Fiberoptic Laryngoscopes

OBJECTIVE

To compare the effectiveness of disinfection protocols utilizing a ultraviolet (UV) Smart D60 light system with Impelux™ technology with a standard Cidex ortho-phthalaldehyde (OPA) disinfection protocol for cleaning flexible fiberoptic laryngoscopes (FFLs).

METHODS

Two hundred FFLs were tested for bacterial contamination after routine use, and another 200 FFLs were tested after disinfection with one of four methods: enzymatic detergent plus Cidex OPA (standard), enzymatic detergent plus UV Smart D60, microfiber cloth plus UV Smart D60, and nonsterile wipe plus UV Smart D60. Pre- and post-disinfection microbial burden levels and positive culture rates were compared using Kruskal-Wallis ANOVA and Fisher's two-sided exact, respectively.

RESULTS

After routine use, approximately 56% (112/200) of FFLs were contaminated, with an average contamination level of 9,973.7 ± 70,136.3 CFU/mL. The standard reprocessing method showed no positive cultures. The enzymatic plus UV, microfiber plus UV, and nonsterile wipe plus UV methods yielded contamination rates of 4% (2/50), 6% (3/50), and 12% (6/50), respectively, with no significant differences among the treatment groups (p > 0.05). The pre-disinfection microbial burden levels decreased significantly after each disinfection technique (p < 0.001). The average microbial burden recovered after enzymatic plus UV, microfiber plus UV, and nonsterile wipe plus UV were 0.40 CFU/mL ± 2, 0.60 CFU/mL ± 2.4, and 12.2 CFU/mL ± 69.5, respectively, with no significant difference among the treatment groups (p > 0.05). Micrococcus species (53.8%) were most frequently isolated, and no high-concern organisms were recovered.

CONCLUSION

Disinfection protocols utilizing UV Smart D60 were as effective as the standard chemical disinfection protocol using Cidex OPA.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:3512-3519, 2023.

A cost comparison between reusable flexible and disposable laryngoscopes

OBJECTIVES

To compare the costs of disposable laryngoscopes to reusable scopes in outpatient and inpatient settings.

METHODS

The total variable and fixed costs involved in flexible scope reprocessing were collected from two general otolaryngology clinics, a pediatric otolaryngology clinic, and a children's hospital. Variable costs of disposable materials and labor were collected from 65 scope reprocessing events to identify the cost of reprocessing. Fixed costs of scope maintenance, monitors, video towers, and storage equipment were collected from financial records. Fixed and variable costs were analyzed to identify the cost per scope event. The costs were then compared to a theoretical model where disposable scopes were used to meet the volume demands of each clinic and children's hospital setting. The model of disposable scopes was generated after obtaining volume costs specific to each setting from a disposable scope company.

RESULTS

The average cost of a reusable scope model per scope event was $66.02 ± 4.49 at the three clinics and $130.66 at the children's hospital. The average cost of the disposable scope model per scope event was $152.55 ± 0.55 in the three clinics and $172.61 in the children's hospital. The cost differences were $86.53 ± 3.96 and $41.95 respectively.

CONCLUSIONS

In an outpatient clinic, reusable scopes are less expensive than a disposable scope model. In children's hospital inpatient setting, the difference in costs between disposable and reusable scopes is lower. When considering other non-economic factors, disposable scopes may be a feasible option, especially in the children's hospital setting.

[Hygiene in ENT examination: Fluorescence study with overview of current recommendations]

Increasing normative demands on patient safety and quality assurance measures, but also the problem of multi-resistant germs and pathogens with a high potential for infection, increase the need for hygienically correct work.In this study, hygienically relevant potential sources of contamination in ENT examinations were to be identified and possible improvement strategies examined.A complete ENT examination was performed by 5 examiners with different professional experience, whose gloves were wetted with fluorescent lotion prior to the examination. Contaminations especially on the examination unit and on the instruments were identified. The potential risk of transmission of pathogens to subsequent patients was assessed using a specially developed score. Various strategies to reduce identified contamination possibilities were developed and thought through.The score of the investigators was very high with an average of 87.4 points (±3.6). The implementation of individual hygiene measures during the examination process would lead to a significant reduction of the score and thus to an improvement in hygiene: No shaking of hands (81.8), additional disinfection of patient's chair (79.8), disinfection of important surfaces (69.8), provision of standard instruments (60.2) or all instruments (32.2), disinfection of all relevant surfaces and provision of all instruments (7.4).The results show very clearly that an ENT examination is a complex procedure from the point of view of hygiene. For reliable protection against possible transmission events, a structured bundling of hygiene measures is therefore necessary.

Experimental Study to Develop a Method for Improving Sample Collection to Monitor Laryngoscopes after Reprocessing

BACKGROUND/AIMS

The microbiological surveillance of endoscopes and automated flexible endoscope reprocessing have been proven to be two of the most difficult and controversial areas of infection control in endoscopy. The purpose of this study was to standardize a sampling method for assessing the effectiveness of standard reprocessing operating procedures for flexible fiberoptic laryngoscopes (FFLs).

METHODS

First, the sampling devices were directly inoculated with Bacillus atrophaeus spores; second, tissue non tissue (TNT) wipes were tested on artificially contaminated surfaces and on FFLs.

RESULTS

Comparison of the sponges, cellulose, and TNT wipes indicated that the TNT wipes were more effective in releasing spores (93%) than the sponges (49%) and cellulose wipes (52%). The developed protocol provides a high efficiency for both collection and extraction from the stainless steel surface (87% of the spores were removed and released) and from the FFL (85% of the spores were removed and released), with relatively low standard deviations for recovery efficiency, particularly for the analysis of the FFL.

CONCLUSION

TNT wipes are more efficient for sampling surface areas, thereby aiding in the accuracy and reproducibility of environmental surveillance.

A randomised, single-blind comparison of high-level disinfectants for flexible nasendoscopes

OBJECTIVES

To compare the microbiological efficacy, turnaround time, cost, convenience, and patient and user tolerance of Tristel Trio Wipes, PeraSafe solution and Cidex OPA solution for the high-level disinfection of flexible nasendoscopes.

METHODS

Flexible nasendoscopes were used in routine clinical encounters. They were then disinfected with one of the three disinfectant methods. Surveillance cultures were taken before and after each disinfection process. Data relating to each of the study parameters were recorded.

RESULTS

Positive bacterial cultures were discovered on nasendoscopes disinfected with PeraSafe and Cidex OPA. Tristel Trio Wipes have no capital outlay cost, the lowest running cost, the greatest convenience and the fastest turnaround time. PeraSafe had a faster turnaround time than Cidex OPA, and lower running costs.

CONCLUSION

Tristel Trio Wipes are equal to PeraSafe and Cidex OPA in terms of microbiological efficacy. Turnaround time and cost are dramatically reduced when using Tristel Trio Wipes compared to the other disinfectant methods.

[Disinfection and recontamination of rigid endoscopes: improved safety using an immersion quiver system]

BACKGROUND

In Otorhinolaryngology, rigid endoscopes are used daily at a high frequency. There is no consensus for reprocessing these medical instruments. Often immersion disinfection procedures are used. The present study examined the possible risk of recontamination by this disinfection method and investigated the possibility of avoiding this risk by using a new immersion quiver system.

METHODS

Using coloured markers, a possible contact of the endoscope with the top edges of quivers of different diameters during endoscope removal was tested for. In addition, it was evaluated whether Staphylococcus aureus transfer is possible via this route. The same methodology was applied to a new immersion quiver system.

RESULTS

Whenever removing the rigid endoscopes from the conventional quiver, these touched the top of the quiver, regardless of its diameter. A transfer of Staphylococcus aureus from the quiver to the endoscope via this route could be detected in five out of eight attempts. During endoscope removal from the new immersion quiver system, no contact of the endoscope with the outer quiver occurred in 20 passes. In none of eight trials was a transfer of Staphylococcus aureus from previously contaminated immersion quivers to the endoscope shown; all immersion quivers were sterile after disinfection.

DISCUSSION

After conventional immersion disinfection, recontamination of rigid endoscopes by a contaminated quiver edge is possible. An immersion quiver system can resolve this risk of recontamination easily, by decontaminating not only the endoscope, but also the immersion quiver (inner quiver) itself in the disinfectant solution.

An evaluation of varying protocols for high-level disinfection of flexible fiberoptic laryngoscopes

OBJECTIVES/HYPOTHESIS

The use of flexible fiberoptic laryngoscopes (FFLs) is ubiquitous in otolaryngology practices. As with any medical device, there exists a small risk for transmission of pathogenic microorganisms between patients, necessitating high-level decontamination between uses. Most of the literature to date has studied channeled scopes such as those used in esophagogastroduodenoscopy and colonoscopy. A recent study of nonchanneled flexible laryngoscopes suggested that current high-level decontamination practices in use at some institutions, including ours, may be overly aggressive. We sought to evaluate and compare the efficacy of varying techniques of high-level disinfection of FFLs.

STUDY DESIGN

FFLs were used in routine clinical encounters and then disinfected with a variety of techniques. The FFLs were then cultured for bacteria and fungi, and the rates of positive cultures were compared between the techniques and the controls.

METHODS

In this study, we took FFLs following use in routine clinical practice and disinfected them using one of eight decontamination protocols. We compared the bacterial and fungal culture results to positive and negative controls.

RESULTS

We demonstrated that each of the eight cleaning protocols was statistically efficacious at removing bacterial contamination. Our results for fungal cultures did not reach statistical significance.

CONCLUSIONS

Using in vitro inoculation of FFLs, this study demonstrated that quicker and more cost-effective practices are equally efficacious to more time-consuming and expensive techniques with regard to bacterial contamination of FFLs.

LEVEL OF EVIDENCE

NA

Microbiological sampling of the forgotten components of a flexible fiberoptic laryngoscope: what lessons can we learn?

The effectiveness of a Cidex-based decontamination protocol was analyzed for its effectiveness in cleaning various components of a flexible fiberoptic laryngoscope (FFL), including the handle, eyepiece, and detachable light cable. A random microbiological sampling and aerobic bacterial culture analysis of 6 FFL eyepieces, 6 FFL driver handles, and 5 light cables prior to patient use was performed. Of 17 samples collected, 7 (41%) were contaminated with bacterial organisms. Organisms recovered represented both environmental organisms from skin and oral flora origin. This study demonstrates that potential contaminants may be present on FFL eyepieces and light cables, which are commonly overlooked in the cleaning protocols of a standard otolaryngology clinic.

How clean is your scope? A completed audit cycle of the disinfection of nasendoscopes

INTRODUCTION

Correct disinfection of nasendoscopes is essential to address both the potential iatrogenic transmission of infection and to avoid injury from the chemicals used.

MATERIALS AND METHODS

Standards-based audit of the disinfection of nasendoscopes against the ENT UK guidelines.

INTERVENTION

instructional poster and staff training session. The disinfection process was re-audited one month later.

RESULTS

A total of 10 sessions and 31 cleaning episodes were audited in the first cycle (C1). A total of 12 sessions and 36 cleaning episodes were re-audited in the second cycle (C2). Clinic set-up results: there was a marked improvement in the checking of the expiry date (C1=5/10; C2=10/12; P≤0.001) and recording the date for the solution to be discarded (C1=0/10; C2=10/12; P≤0.048). Each cleaning episode results: an improvement in transportation in a 'dirty bag' (C1=0/31; C2=19/36; P≤0.001), washing of the scope (C1=0/31; C2=36/36; P≤0.001), adequate disinfection time (C1=16/31; C2=33/36; P≤0.001), rinsing and drying with alcohol swab (C1=0/31; C2=35/36; P≤0.001) and placing of the scope in a 'clean bag' for storage (C1=0/31; C2=35/36; P≤0.001) was seen after the intervention.

CONCLUSIONS

The introduction of a poster and training in the disinfection of nasendoscopes proved successful in improving compliance with the published guidelines. These simple measures were simple, cheap and effective to institute. The benefit of improving the disinfection of nasendoscopes to patients, doctors and the organisations that they work in is clear.

A Review of Reprocessing Techniques of Flexible Nasopharyngoscopes

To provide assistance to otolaryngologists to decide the best manner in which to reprocess flexible nasopharyngoscopes, a review of existing English language medical literature regarding the methods of flexible endoscope reprocessing was performed, including previously published guidelines from other medical disciplines. Multiple steps were confirmed to be critical to effectively reprocess flexible nasopharyngoscopes. High-level disinfection has been determined to be the minimum level of disinfection required for reprocessing of flexible nasopharyngoscopes. Several steps are important in all reprocessing techniques, including manual cleaning, leak testing, cleaning with an enzymatic agent, high-level disinfection, and drying with vertical storage. Three techniques are available to achieve high-level disinfection: manual disinfection with a liquid disinfectant/sterilant, use of an automated endoscope reprocessor, and use of a disposable sheath. Achieving high-level disinfection of flexible nasopharyngoscopes can be accomplished by a variety of methods. Strict adherence to recommended procedures is critical.

Prevention of disease transmission during flexible laryngoscopy

The medical literature was reviewed to evaluate the risk of disease transmission and nosocomial infection associated with flexible laryngoscopes. These instruments have been reported to be contaminated with blood, body fluids, organic debris, and potentially pathogenic microorganisms during routine clinical use. Failure to reprocess properly a flexible laryngoscope may, therefore, result in patient-to-patient disease transmission. Different types of biocidal agents, including 70% isopropyl alcohol, quaternary ammonium compounds, and 2% glutaraldehyde have been reported to be used to disinfect flexible laryngoscopes. A logic, or algorithm, was developed to evaluate the adequacy of these and other types of biocidal agents used during instrument reprocessing. This review determined that flexible laryngoscopes are semicritical instruments that require high-level disinfection (or sterilization) to prevent nosocomial infection. Whereas 70% isopropyl alcohol, quaternary ammonium compounds, and other products that achieve intermediate-level or low-level disinfection are contraindicated for reprocessing flexible laryngoscopes, 2% glutaraldehyde and other products that achieve high-level disinfection (or sterilization) are recommended for reprocessing these instruments to prevent nosocomial infection. A formal set of step-by-step guidelines for reprocessing flexible laryngoscopes is provided. Use of a disposable sheath to cover and protect the flexible laryngoscope from contamination during clinical use is discussed.