Decontamination of laryngoscopes: a survey of national practice

Disinfection of Reusable Laryngoscopes: A Survey about the Clinical Practice in Spain

Airway device-associated infections resulting from the cross-contamination of reusable laryngoscopes are one of the main causes of healthcare-associated infections. Laryngoscope blades are highly contaminated with various pathogens, including Gram-negative bacilli, which can cause prolonged hospitalization, high morbidity and mortality risks, the development of antibiotic-resistant microorganisms, and significant costs. Despite the Centers for Disease Control and Prevention and the American Society of Anesthesiologists' recommendations, this national survey of 248 Spanish anesthesiologists showed that there is great variability in the processing of reusable laryngoscopes in Spain. Nearly a third of the respondents did not have an institutional disinfection protocol, and 45% of them did not know the disinfection procedure used. Good practices for the prevention and control of cross-contamination can be ensured through compliance with evidence-based guidelines, education of healthcare providers, and audits of clinical practices.

Disposable laryngoscope intubation to reduce equipment failure in an emergency out of OR setting - a quality control case study

BACKGROUND

Reusable laryngoscopes have been reported to be superior to disposable laryngoscopes with plastic blades during emergent intubations. Surprisingly, at our institution a quality reporting system revealed a high number of equipment failures with reusable laryngoscopes in an emergency out-of-OR (operating room) setting. As recent studies indicated an improved quality of disposable laryngoscopes, we hypothesized that a thoroughly evaluated disposable laryngoscope would result in less equipment failure in an emergency out-of-OR setting.

METHODS

To perform a more standardized and time efficient analysis, four distinct disposable laryngoscope blade/handle configurations were trialed during standard intubations (n = 4 × 30) in the OR by experienced anesthesia providers who completed a 6-question, Likert-scale/open-ended survey for product evaluation. The 'best' disposable blade was implemented in an emergency out-of-OR setting and equipment failure rates were monitored over a 3-year period.

RESULTS

Different disposable laryngoscopes were equal regarding sturdiness, illumination and airway visualization. The laryngoscope with the highest overall score was significantly higher scored than the laryngoscope with the lowest overall score. All disposable laryngoscopes were more cost effective than the reusable ones, and the top scored laryngoscope demonstrated the highest 5-year cost-saving ($210 K). Implementation of the top scored disposable laryngoscope into an emergency out-of-OR setting reduced the equipment failure incidence from high 20s to 0.

CONCLUSION

Disposable laryngoscopes are cost effective and superior to reusable laryngoscopes in an emergency out-of-OR setting. We demonstrate that the implementation of a disposable laryngoscope in the emergency out-of-OR setting resulted in a near elimination of equipment related quality submissions which ultimately enhances patient safety.

Decontamination Issues and Perceived Reliability of the Laryngoscope—A Clinician's Perspective

The laryngoscope is identified as a potential vector for cross-infection. Case reports are presented, as are reports of bacterial and occult blood contamination of laryngoscope blades and handles. Infection control policies covering laryngoscope blade and handle processing are outlined relative to procedures of a teaching hospital department. Repeated decontamination of laryngoscope blades has resulted in a perceived decrease in reliability. This is reflected in a departmental survey where 86% of respondents consider the standard laryngoscope is only intermittently reliable and that there is room for improvement.

Bacterial Contamination and Disinfection Status of Laryngoscopes Stored in Emergency Crash Carts

Objectives

To identify bacterial contamination rates of laryngoscope blades and handles stored in emergency crash carts by hospital and area according to the frequency of intubation attempts.

Methods

One hundred forty-eight handles and 71 blades deemed ready for patient use from two tertiary hospitals were sampled with sterile swabs using a standardized rolling technique. Samples were considered negative (not contaminated) if no colonies were present on the blood agar plate after an 18-hour incubation period. Samples were stratified by hospital and according to the frequency of intubation attempts (10 attempts per year) using the χ²-test and Fisher exact test.

Results

One or more species of bacteria were isolated from 4 (5.6%) handle tops, 20 (28.2%) handles with knurled surfaces, and 27 (18.2%) blades. No significant differences were found in microbial contamination levels on the handle tops and blades between the two hospitals and two areas according to the frequency of intubation attempts. However, significant differences were found between the two hospitals and two areas in the level of microbial contamination on the handles with knurled surfaces (p<0.05).

Conclusions

Protocols and policies must be reviewed to standardize procedures to clean and disinfect laryngoscope blades and handles; handles should be re-designed to eliminate points of contact with the blade; and single-use, one-piece laryngoscopes should be introduced.

Laryngoscope decontamination techniques: A survey

Background and Aims:

India is a vast country with variable, nonuniform healthcare practices. A laryngoscope is an important tool during general anesthesia and resuscitation. The study aimed to determine the current practices of laryngoscope decontamination in India.

Material and Methods:

An online survey was conducted amongst 100 anesthesiologists to determine the common methods of laryngoscope decontamination adopted in their settings. The survey was done over 6 months after validating the questionnaire.

Results:

A total of 73 responses were received out of 100. The result of the survey revealed that there is no uniform technique of laryngoscope decontamination. There is marked variability in techniques followed not only among different institutions, but also within the same institution.

Conclusion:

There are no fixed protocols adopted for laryngoscope decontamination. Thus, there is a need to develop definitive guidelines on this subject, which can be implemented in India.

Double gloves: a randomized trial to evaluate a simple strategy to reduce contamination in the operating room

BACKGROUND

Oral flora, blood-borne pathogens, and bacterial contamination pose a direct risk of infection to patients and health care workers. We conducted a study in a simulated operating room using a newly validated technology to determine whether the use of 2 sets of gloves, with the outer set removed immediately after endotracheal intubation, may reduce this risk.

METHODS

Forty-one anesthesiology residents (PGY 2-4) were enrolled in a study consisting of individual or group simulation sessions. On entry to the simulated operating room, the residents were asked to perform an anesthetic induction and tracheal intubation timed to approximately 6 minutes; they were unaware of the study design. Of the 22 simulation sessions, 11 were conducted with the intubating resident wearing single gloves, and 11 with the intubating resident using double gloves with the outer pair removed after verified intubation. Before the start of the scenario, we coated the lips and inside of the mouth of the mannequin with a fluorescent marking gel as a surrogate pathogen. After the simulation, an observer examined 40 different sites using a handheld ultraviolet light in the operating room to determine the transfer of surrogate pathogens to the patient and the patient's environment. Residents who wore double gloves were instructed by a confederate nurse to remove the outer set immediately after completion of the intubation. Forty sites of potential intraoperative pathogen spread were identified and assigned a score.

RESULTS

The difference in the rate of contamination between anesthesiology residents who wore single gloves versus those with double gloves was clinically and statistically significant. The number of sites that were contaminated in the operating room when the intubating resident wore single gloves was 20.3 ± 1.4 (mean ± SE); the number of contaminated sites when residents wore double gloves was 5.0 ± 0.7 (P < 0.001).

CONCLUSIONS

The results of this study suggest that when an anesthesiologist wears 2 sets of gloves during laryngoscopy and intubation and then removes the outer set immediately after intubation, the contamination of the intraoperative environment is dramatically reduced.

Chlorhexidine to maintain cleanliness of laryngoscope handles: an audit and laboratory study

CONTEXT

Laryngoscope handles are a potential vector for infection transmission and require adequate decontamination.

OBJECTIVE

To establish an effective cleaning regimen for laryngoscope handles.

DESIGN

Three laboratory studies and an audit cycle.

SETTING

The Queen Elizabeth Hospital, King's Lynn, UK.

MATERIALS

Twenty Heine laryngoscope handles.

INTERVENTIONS

Twenty laryngoscope handles were contaminated with microbial broth and then disinfected with chemical wipes, either using Sani-Cloth CHG 2% (chlorhexidine 2%/alcohol 70%) or Tuffie 5 wipes. This was repeated with an interval of 24 h between cleaning and contamination. A further experiment repeatedly re-contaminated the handles at varying time intervals after cleaning. The audit established the current level of contamination of laryngoscope handles within the hospital, and this was repeated following a change in cleaning protocol.

MAIN OUTCOME MEASURES

Bacterial growth on agar plates was counted as the number of colony forming units.

RESULTS

Both Sani-Cloth CHG 2% and Tuffie 5 wipes were effective against microorganisms, including methicillin-resistant Staphylococcus aureus, immediately following wiping (P = 0.002). However, the chlorhexidine wipes also had a residual effect such that after wiping, the handle remained sterile following further contamination and this effect persisted for 24 h. Audit following the introduction of this practice showed significant improvements in the incidence and extent of contamination compared with the previous disinfection practice (P<0.002).

CONCLUSION

Decontamination with Sani-Cloth CHG 2% wipes confers additional advantages over routine autoclaving or handle disposal, due to a residual effect. Autoclaving handles may be desirable on a scheduled basis and if Clostridium difficile is encountered.

Multi-resistant viridans streptococcal pneumonia and sepsis in the ventilated newborn

Mechanical ventilation increases the frequency of nosocomial infections. This study describes the frequency of multi-resistant viridans streptococcal colonisation, the clinical course of nosocomial sepsis and ventilator-associated pneumonia in mechanically ventilated neonates in the neonatal intensive care unit of Ankara University Hospital. Seventy-nine ventilated newborns were enrolled. Broncho-alveolar lavage culture and blood cultures were positive in 44 (56%) and 17 (22%) patients, respectively. The most predominant micro-organisms in broncho-alveolar lavage cultures were multi-resistant viridans streptococci (29, 66%). Viridans streptococci were also one of the predominant organisms in blood cultures (5/17, 29%). In 29 patients with broncho-alveolar lavage positive for viridans streptococci, nine (31%) had colonisation, 15 (52%) had ventilator-associated pneumonia and five (17%) had sepsis owing to viridans streptococcus. Ventilator-associated pneumonia was encountered in 52/1000 ventilation days. Mortality was caused by infection in three (10%) of them. Mechanically ventilated neonates in our neonatal intensive care unit had a high rate of both multi-resistant viridans streptococcus airway colonisation and subsequent ventilator-associated pneumonia and sepsis.

Randomized crossover comparison of the laryngeal mask airway classic with i-gel laryngeal mask airway in the management of difficult airway in post burn neck contracture patients

PURPOSE

The objective of the study was to compare the performance of i-gel supraglottic airway with cLMA in difficult airway management in post burn neck contracture patients and assess the feasibility of i-gel use for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening.

METHODS

Prospective, crossover, randomized controlled trial was performed amongst forty eight post burn neck contracture patients with limited mouth opening and neck movement. i-gel and cLMA were placed in random order in each patient. Primary outcome was overall success rate. Other measurements were time to successful ventilation, airway leak pressure, fiberoptic glottic view, visualization of square wave pattern.

RESULTS

Success rate for the i-gel was 91.7% versus 79.2% for the cLMA. i-gel required shorter insertion time (19.3 seconds vs. 23.5 seconds, P=0.000). Airway leak pressure difference was statistically significant (i-gel 21.2 cm H20; cLMA 16.9 cm H(2)0; P=0.00). Fiberoptic view through the i-gel showed there were less epiglottic downfolding and better fiberoptic view of the glottis than cLMA. Overall agreement in insertion outcome for i-gel was 22/24 (91.7%) successes and 2/24(8.3%) failure and for cLMA, 19/24 (79.16%) successes and 5/24 (16.7%) failure in the first attempt.

CONCLUSION

The i-gel is cheap, effective airway device which is easier to insert and has better clinical performance in the difficult airway management of the airway in the post burn contracture of the neck. Our study shows that i-gel is feasible for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening in post burn neck.

Sequential cohort study comparing chlorine dioxide wipes with automated washing for decontamination of flexible nasendoscopes

Introduction:

Flexible nasoendoscope is an important tool in otorhinolaryngology practice. The endoscope needs to be decontaminated prior to use in the next patient. The 2005 ENT-UK guidance for cleaning fibre-optic laryngoscopes stated that the ideal disinfecting agent and process should be effective and have low capital and maintenance costs.

Objective:

To compare the efficacy and cost-effectiveness of chlorine dioxide wipes versus automated washer, for decontamination of flexible nasendoscopes.

Methods:

A sequential cohort,in vitrostudy was performed to test the efficacy of chlorine dioxide wipes and automated washer. Costs were also calculated.

Results:

After deliberate bacterial contamination of the nasendoscope and subsequent decontamination, swab samples from the endoscope showedStaphylococcus epidermidisgrowth in 2 per cent (1/50 swabs) of the chlorine dioxide wipe group and in 28 per cent (14/50 swabs) of the automated washer group (p = 0.00). Based on a projected 10-year cost calculation, the automated washer was cheaper.

Conclusion:

Further studies are required to test whether these results are replicable. A similar study should be performed using real patients, to check the significance of improper decontamination.

Nosocomial contamination of laryngoscope handles: challenging current guidelines

BACKGROUND

Laryngoscope blades are often cleaned between cases according to well-defined protocols. However, despite evidence that laryngoscope handles could be a source of nosocomial infection, neither our institution nor the American Society of Anesthesiologists has any specific guidelines for handle disinfection. We hypothesized that laryngoscope handles may be sufficiently contaminated with bacteria and viruses to justify the implementation of new handle-cleaning protocols.

METHODS

Sixty laryngoscope handles from the adult operating rooms were sampled with premoistened sterile swabs. Collection was performed between cases, in operating rooms hosting a broad variety of subspecialty procedures, after the room and equipment had been thoroughly cleaned for the subsequent case. Samples from 40 handles were sent for aerobic bacterial culture, and antimicrobial susceptibility testing was performed for significant isolates. Samples from 20 handles were examined for viral contamination using a polymerase chain reaction assay that detects 17 respiratory viruses.

RESULTS

Of the 40 samples sent for culture, 30 (75%) were positive for bacterial contamination. Of these positive cultures, 25 (62.5%) yielded coagulase-negative staphylococci, seven (17.5%) Bacillusspp. not anthracis, three (7.5%) alpha-hemolytic Streptococcusspp., and one each (2.5%) of Enterococcusspp., Staphylococcus aureus(S. aureus), and Corynebacteriumspp. No vancomycin-resistant enterococci, methicillin-resistant S. aureus, or Gram-negative rods were detected. All viral tests were negative.

CONCLUSION

We found a high incidence of bacterial contamination of laryngoscope handles despite low-level disinfection. However, no vancomycin-resistant enterococci, methicillin-resistant S. aureus, Gram-negative rods, or respiratory viruses were detected. Our results support adoption of guidelines that include, at a minimum, mandatory low-level disinfection of laryngoscope handles after each patient use.

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.

User satisfaction and forces generated during laryngoscopy using disposable Miller blades: a manikin study

Increasing awareness of prion-related diseases has led to an increase in the number of disposable laryngoscope blades available. We compared 11 disposable and standard re-usable Miller size 1 blades. In this manikin-based study, we studied user satisfaction for field of view at laryngoscopy, build quality and users' willingness to use the blade in an emergency situation. These were found to be better with metal disposable blades (p</=0.001). Vertical and horizontal forces developed during laryngoscopy were greater with plastic than with metal blades.

Changes in the Light Intensity of the Fiberoptic Laryngoscope Blade by Steam Sterilization

BACKGROUND

I investigated the effects of steam sterilization on light intensity of reusable fiberoptic laryngoscope blades.

METHODS

Six new reusable fiberoptic Macintosh laryngoscope blades were steam sterilized. The light intensity was measured, the tip of the blades was photographed, and the light intensity of six new plastic disposable Macintosh laryngoscope blades was also measured.

RESULTS

The light intensity of reusable blades exceeded that of the disposable blades after 20 sterilizations, but was significantly lower after 80 sterilizations. The photographs showed irregular lighting of the blades, which increased with repeated sterilization.

CONCLUSIONS

Disposable plastic blades provide more illumination than reusable fiberoptic blades subjected to repeated sterilization.

Recommendations to resolve inconsistent guidelines for the reprocessing of sheathed and unsheathed rigid laryngoscopes

Neither a consensus statement nor a formal set of step-by-step guidelines for reprocessing rigid laryngoscopes have been published or endorsed by professional organizations. Several published guidelines, standards, and clinical reports were reviewed to evaluate the risk of nosocomial infection associated with the use of rigid laryngoscopes, to determine their minimum reprocessing requirements. This review found that the recommendations of some guidelines and standards for reprocessing rigid laryngoscopes are incomplete, inadequate, and inconsistent with one another, and that current practices for reprocessing rigid laryngoscopes are reported to be inadequate and lack standardization. It is recommended that a consensus statement be developed that standardizes the reprocessing of rigid laryngoscopes and requires cleaning followed by high-level disinfection (or sterilization) and drying of the rigid laryngoscope's blade and handle to prevent nosocomial infection, regardless of whether a protective barrier or sheath is used during the procedure.

A comparison of the Soft Sealtm disposable and the Classic re-usable laryngeal mask airway*

Many new supraglottic airway devices have been recently introduced, their development motivated by the need for a single-use equivalent to the original re-usable laryngeal mask airway. We performed a randomised cross-over study in spontaneously breathing patients comparing the re-usable Laryngeal Mask Airway-Classic (LMA) and the disposable Soft Seal Laryngeal Mask in sizes 3, 4 and 5. Sixty patients had an LMA and a disposable laryngeal mask placed in random order. The primary outcome was first attempt insertion success rate. Ease of insertion was similar in both groups and there was no difference in first attempt success rates (96% with LMA and 92% with disposable laryngeal mask). The disposable laryngeal mask required significantly less air to inflate the cuff to produce a seal (10 [10-25] ml with disposable laryngeal mask and 15 [10-30] ml with laryngeal mask) and the cuff pressure produced was significantly lower (35 [20-80] cmH(2)O with disposable laryngeal mask and 75 [20-120] cmH(2)O with LMA). Data are median and range. We conclude that the disposable laryngeal mask is an acceptable alternative to the re-usable LMA.

Lymphocyte contamination of laryngoscope blades - a possible vector for transmission of variant Creutzfeldt-Jakob disease

Variant Creutzfeldt-Jakob disease (vCJD) is associated with extensive prion infection of lymphoreticular tissues during the prolonged asymptomatic incubation period. Instruments exposed to infected tissues of preclinically infected individuals during medical or surgical procedures represent a potential risk of iatrogenic transmission of vCJD prions. We assessed the frequency of contamination with lymphoid tissue of single-use laryngoscope blades used for tracheal intubation for general anaesthesia. Using a cyto-centrifugation technique, lymphocytes were detected from 30% of laryngoscope blades studied. As prions resist routine sterilisation procedures, the use of non-disposable laryngoscope blades poses a risk of transmitting vCJD from patient to patient. The use of such instruments should be abandoned and disposable alternatives used.

[Disposable material for tracheal intubation: pilot study using Penlon Crystal blades and Penlon Lary Gard sheaths]

OBJECTIVE

The risk of cross infection due to non-conventional infectious agents has led to the development of single-use disposable medical material. For laryngoscopy, two attitudes have been proposed: the use of disposable blades or disposable translucide cover sheaths with steel blades. Practice studies assessing the quality of these devices are scarce, leaving the physician to his own experience.

STUDY DESIGN

Open pilot study assessing satisfaction of the users during tracheal intubation.

PATIENTS AND METHODS

Hundred patients of general surgery requiring tracheal intubation underwent laryngoscopy in routine condition with disposable blades (Penlon Crystal) or disposable cover sheaths (Penlon Lary Gard) with steel blades. The users gave a general appreciation of the device and specific comments on the easiness of insertion of the blade, intensity of light and its focus, quality of glottic exposure, easiness of tracheal tube insertion, and solidity of the device.

RESULTS

With both devices, intubation was impossible in 6% of the patients. The users considered that intubation was performed in comfortable conditions with both devices. Dim light was noticed with Crystal blade.

CONCLUSION

In case of use of disposable material, both devices seem to be close in terms of quality of intubation.

[Airway equipment and its maintenance for a non difficult adult airway management (endotracheal intubation and its alternative: face mask, laryngeal mask airway, laryngeal tube)]

The airway equipment for a non difficult adult airway management are described: endotracheal tubes with a specific discussion on how to inflate the balloon, laryngoscopes and blades, stylets and intubation guides, oral airways, face masks, laryngeal mask airways and laryngeal tubes. Cleaning and disinfections with the maintenance are also discussed for each type of airway management.

The effect of mechanical cleaning and thermal disinfection on light intensity provided by fibrelight Macintosh laryngoscopes

The increased use of thermal decontamination procedures for fibrelight laryngoscope blades, to comply with international guidelines, will have considerable economical effects. We evaluated the effect of mechanical cleaning plus thermal disinfection at 90 degrees C, with or without subsequent steam sterilisation at 134 degrees C, on light intensity provided by fibrelight laryngoscopes. After mounting the blades in a special frame with a built-in light source, light intensity was measured using radiometer/photometer. In total, 14 blades provided by 11 companies were tested. The majority of fibrelight laryngoscope blades were fairly resistant to the damaging effects of machine washing plus disinfection at 90 degrees C (mean [range] reduction in light intensity 34.6%[2.1-78.3%]). However, when exposed to an additional sterilisation procedure at 134 degrees C, the majority of blades were unable to withstand the combined treatment for 300 cycles (mean [range] reduction in light intensity 86.5%[32.0-98.7%]). This study stresses the need for fibrelight laryngoscope blades which are more resistant to thermal decontamination procedures than those available at present.

Eliminating protein from reusable laryngeal mask airways. A study comparing routinely cleaned masks with three alternative cleaning methods

Laryngeal mask airways (LMAs) have the potential to act as a vector for the transmission of prion diseases. This study was undertaken to define the problem of protein contamination and to investigate three alternative cleaning methods. Forty-eight LMAs were allocated to one of four groups, stained with erythrosin and given a total stain score and a grid stain score in order to determine the degree of protein contamination. Eighteen randomly selected LMAs that had been routinely cleaned and sterilised (group 1) were compared with 12 LMAs that had been washed and scrubbed with the benefit of prior staining (group 2), 13 that had been washed and scrubbed without any visual guide (group 3) and 13 that had been cleaned using a Biosonic ultrasonic cleaning system (group 4). The results show that none of the cleaning methods achieved optimal results, as all methods left proteinaceous material on some masks. The study showed that: (i) staining as a guide to cleaning does not lead to more effective removal of proteinaceous material; (ii) systematic cleaning and scrubbing does lead to more effective removal of proteinaceous material from surfaces other than the grid area; and (iii) ultrasonic cleaning was more effective than other methods of cleaning for the removal of proteinaceous material from those areas of the mask most inaccessible, such as the grid.

Common faults in resuscitation equipment--guidelines for checking equipment and drugs used in adult cardiopulmonary resuscitation

Successful advanced life support relies, in part, upon the availability and correct functioning of resuscitation equipment. However, numerous publications report deficiencies and defects in key items of resuscitation equipment, particularly those relating to airway management and defibrillation. Some of these are generic and relate to basic device failure (e.g. intrinsic design faults, manufacturing errors, random component failure), external factors (e.g. power failure, gas supply failure, electromagnetic interference) and human error (notably, inadequate knowledge, lack of experience and training, inadequate checking, insufficient maintenance). However, others are device specific. This paper identifies the common, generic faults that lead to equipment malfunction and recommends the resuscitation equipment essential for successful cardiopulmonary resuscitation. It also describes examples of specific equipment malfunction and makes suggestions for the nature and frequency of resuscitation equipment and drug checks, using a structured, and easy-to-recall list.

The effect of single use laryngoscopy equipment on illumination for tracheal intubation

We measured the illumination generated by all 30 Macintosh size 3 laryngoscopes in our department with a lux-meter and a standardised laryngoscope holding tube. We found a large range in illumination generated (65-3130 lx). We then measured the effect on the illumination for each laryngoscope by covering the blade with a cover (LaryGard). In every case, the illumination was reduced by the LaryGard, the mean (SD) reduction was 67 (19)%. When we compared the illumination generated by a disposable laryngoscope blade with the same power source, we found that the illumination was reduced less than with the standard Macintosh covered by a LaryGard.

Cross infection and the laryngoscope

Laryngoscope blades and handles that have been inadequately decontaminated or are unsterile can be harmful to patients. The literature suggests that this may be a current problem in many operating departments. David Pidduck examines the risks to patients that could be posed by current practice, reviews the literature on the subject, and makes some recommendations for change. He encourages nurses and operating department practitioners (ODPs) to take a more proactive approach to highlighting these problems.

Manual cleaning and disinfection of flexible endoscopes--an approach to evaluating a combined procedure

Compliance in endoscope reprocessing is unsatisfactory worldwide. The success of the reprocessing procedure relies upon both disinfection and cleaning. Products for instrument disinfection have to be tested accordingly. However, there is still no accepted standard against which to test the result of the cleaning procedure. Different strategies for endoscope reprocessing are possible: one- or two-step procedures. The decision for the method chosen strongly depends on the possibilities in individual hospitals. Products based on glutaraldehyde should not be used if it is not absolutely certain that instruments are already clean. There has to be an awareness that instruments are not designed for easy cleaning. A one-step procedure with products based on aliphatic amines could be an alternative. Methods of assessing such a procedure are suggested.

Developing an infection control for anaesthetic equipment

Hospital risk management demands the development of broad and inclusive infection control policies. This is particularly true for anaesthetic equipment where appropriate recommendations on decontamination measures remains a difficult subject for infection control teams since there are no national guidelines. It is a topic which has perhaps been neglected in hospital infection control policies despite the widespread use of anaesthetic equipment in many clinical areas outside the theatre complex. This article offers practical guidance when preparing an infection control policy for anaesthetic equipment. The cost effectiveness of single patient use items versus reprocessing equipment is discussed. The importance of a multi-disciplinary approach, especially where the evidence base is weak, is highlighted.

Evaluation of the disposable Vital View laryngoscope apparatus

The Vital View laryngoscope (Vital Signs, NJ, USA) consists of a plastic disposable blade containing a fibrelight and a non-disposable handle; there is therefore no need to sterilise the blade and no concern about disintegration of the fibrelight. In a random cross-over design, we compared the Vital View laryngoscope with a conventional metal fibrelight laryngoscope (Welch Allyn, NY, USA) in 100 patients. The Vital View laryngoscope produced a brighter field than the metal laryngoscope (p < 0.001), whereas there was no significant difference in the view of the glottis or the success rate of tracheal intubation. In no patient did any problem occur, such as damage to the laryngoscope blade or loss of light during laryngoscopy. In another 10 patients, prevention of light emission from the side of the laryngoscope blade reduced the brightness (p < 0. 01). This indicated that the brightness of the Vital View laryngoscope is produced by light emission not only from the tip of the blade but also from the side of the blade. Therefore, the disposable Vital View laryngoscope can be used as effectively as a conventional non-disposable laryngoscope.

Decontamination of laryngoscopes in The Netherlands

In this study the decontamination procedures of laryngoscopes in Dutch hospitals are described, based on a structured telephone questionnaire. There were substantial differences between decontamination procedures in Dutch hospitals and the standards of the APIC (Association of Professionals in Infection Control and Epidemiology), CDC (Centers of Disease Control) and ASA (American Society of Anesthesiology) were met in full in 19.4% of the hospitals. The standards of manual decontamination, used in 78% of the 139 hospitals, were particularly disappointing; manual cleaning was considered inadequate in 22.9% of these hospitals and manual disinfection did not meet the standards of the APIC, CDC or ASA in any of these hospitals. Decontamination by instrument cleaning machines as a standard procedure was used in 30 (22%) hospitals. In three of these hospitals the blades were subsequently sterilized. We suggest adherence to the infection control guidelines of the CDC, APIC and ASA, until the safety of less conservative infection control practices are demonstrated.

Microbial contamination of gum elastic bougies

The gum elastic bougie is a simple device that is used to assist in the management of the difficult intubation. It is not uncommon for a bougie to be re-used many times. This study investigated the incidence of microbial contamination of the bougies in one hospital. Potentially pathogenic organisms were identified both on the bougies and in their storage containers. This has implications for their cleaning and maintenance, and raises the question as to whether we should replace them with single-use, disposable devices.