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Bowen AJ, Macielak RJ, Fussell W, Yeakel S, McMillan R, Goates A, Awadallah A, Ekbom DC. Single-use versus reusable rhinolaryngoscopes for inpatient otorhinolaryngology consults: Resident and patient experience. Laryngoscope Investig Otolaryngol 2024; 9:e1203. [PMID: 38362188 PMCID: PMC10866581 DOI: 10.1002/lio2.1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 02/17/2024] Open
Abstract
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.
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Affiliation(s)
- Andrew Jay Bowen
- Division of Otolaryngology‐Head and Neck Surgery, Department of Surgery, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonUnited States
| | | | - Wanda Fussell
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Sarah Yeakel
- Department of Orthopedic SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Ryan McMillan
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Andrew Goates
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Andrew Awadallah
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Dale C. Ekbom
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
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Ezeh UC, Achlatis E, Crosby T, Kwak PE, Phillips MS, Amin MR. The Effectiveness of Ultraviolet Smart D60 in Reducing Contamination of Flexible Fiberoptic Laryngoscopes. Laryngoscope 2023; 133:3512-3519. [PMID: 37485725 DOI: 10.1002/lary.30869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
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.
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Affiliation(s)
- Uche C Ezeh
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Efstratios Achlatis
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Tyler Crosby
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Paul E Kwak
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Michael S Phillips
- Division of Infectious Disease, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
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Ellis J, Park AH, Prussin A. A cost comparison between reusable flexible and disposable laryngoscopes. Am J Otolaryngol 2022; 43:103321. [PMID: 34953249 DOI: 10.1016/j.amjoto.2021.103321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/08/2021] [Indexed: 11/01/2022]
Abstract
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.
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Rohrmeier C, Schneider-Brachert W, Kühnel T, Hitzenbichler F, Holzmann T, Bohr C. [Hygiene in ENT examination: Fluorescence study with overview of current recommendations]. Laryngorhinootologie 2021; 100:434-442. [PMID: 33851374 DOI: 10.1055/a-1408-7046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Christian Rohrmeier
- XXXX PRIVATADRESSE XXXX, Straubing.,Fakultät für Medizin, Universität Regensburg, Regensburg.,HNO-Praxis, Straubing
| | - Wulf Schneider-Brachert
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg
| | - Thomas Kühnel
- Klinik für Hals-Nasen-Ohrenheilkunde, Universität Regensburg, Regensburg
| | - Florian Hitzenbichler
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg
| | - Thomas Holzmann
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg
| | - Christopher Bohr
- Klinik für Hals-Nasen-Ohrenheilkunde, Universität Regensburg, Regensburg
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Hamed MMA, Shamseya MM, Alah IDAND, El Deen El Sawaf G. Estimation of average bioburden values on flexible gastrointestinal endoscopes after clinical use and cleaning: Assessment of the efficiency of cleaning processes. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ditommaso S, Giacomuzzi M, Ricciardi E, Zotti C. Experimental Study to Develop a Method for Improving Sample Collection to Monitor Laryngoscopes after Reprocessing. Clin Endosc 2018; 51:463-469. [PMID: 30130841 PMCID: PMC6182295 DOI: 10.5946/ce.2018.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/10/2018] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Savina Ditommaso
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Monica Giacomuzzi
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Elisa Ricciardi
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Carla Zotti
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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A randomised, single-blind comparison of high-level disinfectants for flexible nasendoscopes. The Journal of Laryngology & Otology 2016; 130:983-989. [PMID: 27669971 DOI: 10.1017/s0022215116008860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Rohrmeier C, Strutz J, Schneider-Brachert W. [Disinfection and recontamination of rigid endoscopes: improved safety using an immersion quiver system]. HNO 2015; 62:746-51. [PMID: 24867489 DOI: 10.1007/s00106-014-2873-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- C Rohrmeier
- Klinik für Hals-Nasen-Ohren-Heilkunde, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland,
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Liming B, Funnell I, Jones A, Demons S, Marshall K, Harsha W. An evaluation of varying protocols for high-level disinfection of flexible fiberoptic laryngoscopes. Laryngoscope 2014; 124:2498-501. [PMID: 24604624 DOI: 10.1002/lary.24665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/10/2014] [Accepted: 03/05/2014] [Indexed: 11/07/2022]
Abstract
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
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Affiliation(s)
- Bryan Liming
- Madigan Army Medical Center, Otolaryngology Head and Neck Surgery Service, Tacoma, Washington
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Bhatt JM, Peterson EM, Verma SP. Microbiological sampling of the forgotten components of a flexible fiberoptic laryngoscope: what lessons can we learn? Otolaryngol Head Neck Surg 2013; 150:235-6. [PMID: 24334960 DOI: 10.1177/0194599813513424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Jay M Bhatt
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California at Irvine Medical Center, Irvine, California, USA
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Lakhani R, Smithard A, Bleach N. How clean is your scope? A completed audit cycle of the disinfection of nasendoscopes. Ann R Coll Surg Engl 2010; 92:587-90. [PMID: 20883605 DOI: 10.1308/003588410x12699663904510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Raj Lakhani
- ENT Department, Wexham Park Hospital, Slough, UK.
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Statham MM, Willging JP. Automated high-level disinfection of nonchanneled flexible endoscopes: Duty cycles and endoscope repair. Laryngoscope 2010; 120:1946-9. [DOI: 10.1002/lary.21051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Collins WO. A Review of Reprocessing Techniques of Flexible Nasopharyngoscopes. Otolaryngol Head Neck Surg 2009; 141:307-10. [DOI: 10.1016/j.otohns.2009.05.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 05/18/2009] [Accepted: 05/20/2009] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- William O. Collins
- Department of Otolaryngology–Head and Neck Surgery, University of Florida College of Medicine
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Muscarella LF. Prevention of disease transmission during flexible laryngoscopy. Am J Infect Control 2007; 35:536-44. [PMID: 17936146 DOI: 10.1016/j.ajic.2006.09.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 09/13/2006] [Accepted: 09/14/2006] [Indexed: 12/18/2022]
Abstract
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.
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