A growing body of evidence has shown that contamination in the anesthesia and emergency work area is resulting in transmissions of Healthcare Associated Infections (HAI) and is a significant healthcare issue. The associated transmission from these infections increase the risk of patient mortality.
The JCO Joint Commission and other organizations have made re-usable blades and handle reprocessing a focus. They are looking for evidence of a consistent and repeatable practice that demonstrates how both the handles and the blades are reprocessed and stored.
Below, Stephen Zisis Bsc M.B.A. of ValleyMed, a long-established Canadian supplier of medical products, explores some recommended options known to help reduce the risk of contamination. ValleyMed specialists frequently advise clients on the most effective equipment and consumable products to enhance their working environment and can be contacted by emailing firstname.lastname@example.org or calling 1-800-862-7616.
How Clean is Clean?
The Center for Disease Control and Prevention and the Association for Professionals in Infection Control and Epidemiology (APIC) classify medical devices according to Spaulding classification system as “critical” and “semi critical” and “non critical”. Laryngoscope blades fall into the semi-critical classification. This category includes medical devices that touch mucous membranes or broken skin.
According to the CDCs Healthcare Infection Control Practices Advisory Committee (HICPAC) semi-critical items are to be either sterilized or subjected to high-level disinfection before reuse. High-level disinfection products include solutions such as Cidex®, SterilOx and Sporicidin. There are a number of sterilization methods used including steam sterilization, chemical sterilization (E.T.O) and Vaporized Hydrogen Peroxide (VHP) sterilizers.
Laryngoscope Blades: The Risks
Laryngoscope blades have been identified as potential vectors for cross contamination and as sources of nosocomial infection. Over 2 million patients in the U.S. per year develop nosocomial infections resulting in 90,000 deaths annually and significant added health care costs, as wells as unanticipated burdens on their families.
Blades tend to have irregular surfaces and crevices that hold on to tissue and other potentially infectious material. A single 380 bed hospital study done in 2001, on a series of supposedly clean, sterile pieces of airway equipment found that 77% of laryngoscope blades taken from the operating room complex, 86% of those taken from an intubation tray in an intensive care recovery room and 100% of those of those taken from medical or surgical wards stained positive for retained protein material suggesting possible incomplete cleaning and disinfection or sterilization.
Reusable vs Disposable Blades
Although the concept of disposable laryngoscope equipment makes sense from the perspective of infection control, several previously published studies of disposable laryngoscope blades have suggested potential concerns from a performance standpoint. One study found a particular brand acceptable in the OR for routine intubations but another study found that several brands of plastic disposable blades required the use of greater peak forces than metal reusable blades and increased the number of intubation attempts significantly.
The Case for 304 Stainless Steel
Stainless steel 304 (SS304) is widely used in many applications. Within the medical device industry SS304 is used where high corrosion resistance, good formability, strength, machining precision, reliability and hygiene is of particular importance.
SS304 offers a number of advantages
- Suitable for many surgical devices
- Reduces the risk of infection from rust and other surfaces imperfections caused by oxidation
- High corrosion resistance
- Antibacterial properties
- It does not stain so it can be reprocessed many times in the medical field
- High Heat resistance up to 1650°F (899°C)
Laryngoscope blades and handles manufactured with SS304 add a level of antibacterial protection to the device. A study by Sreekumari et Al Journal of Material Transactions Vol 46 No 7 2005 PP 1636-1645 found SS304 showed significant reduced bacterial settlement on the surface of the steel. The most vulnerable area for bacterial growth is at the juncture of the welds. This also can be extrapolated to blades and handles that have significant wear and nicks in the metal.
When Should Blades and Handles Be Replaced? Check for These Indications
- If during a visual inspection of your laryngoscope blades nicks or bent areas are seen
- If any cracks are visible in the weld areas including when flexing the blade while installed on the handle. Areas of concerns are where the blade attaches to the blade base or the attachment of the light pipe to the blade tongue
- Any obvious deterioration in the fiber-optic bundles
ValleyMed Recommendation: Orion Concepts Inc – GreenStar Laryngoscopes and Stellar Series Blades
- Manufactured from SS304
- Have passed all the necessary requirements by Steris for low and high temperature reprocessing
- The Stellar Series blades are made with integrated fibre optic bundles to reduce crevices and hard-to-clean areas for better & easier removal of bio-burden.
- Fully compatible with all major manufacturers blades and handles made to ISO 7376 (Green) Standard
- Come with a full 5-year warranty
Munoz –Price et Al Infection Control & Hospital Epidemiology (2018), 0, 1–17
Negiri Dasouza et Al Journal of Hospital Infection 83 (2013) 269-275
Contamination of laryngoscopes Handles \science Direct January 2010 D. Williams J et Al
Comparisons of Direct laryngoscopy managing routine and difficult airways using the McGrath Mac EDL
Anesthesia News August 2014
Fogg D. Expiration dates; alcohol disinfection; OR consents; local anesthesia; marking surgical sites; moderate sedation—Clinical Issues. AORN Journal (2003). www.findarticles.com/p/articles/mi_m0FSL/is_2_78/ai_106762784.
Rutala W. APIC guidelines for selection and use of disinfectants. Am J Infection Control, pp. 313–342, Aug 1996. 3. Sterilization or disinfection of medical devices: General principles. Aug 2002. Centers for Disease Control. www.cdc.gov/ncidod/hip/Sterile/Sterilgp.htm.
FDA-cleared sterilants and high-level disinfectants with general claims for processing reusable medical and dental devices. 3 Nov 2003. Device Evaluation Information. U.S. Food and Drug Administration. www.fda.gov/cdrh/ode/germlab.html.
Foweraker JE. The laryngoscope as a potential source of cross infection. J Hosp Infect 29:315–316, 1995.
Neal TJ, Hughes CR, Rothburn MM, Shaw NJ. The neonatal laryngoscope as a potential source of cross-infection. J Hosp Infect 29:315–317, 1995. Clark A, Houston S. Nosocomial infections: An issue of patient safety, Part 2. Clinical Nurse Specialist, pp. 62–64, 2004.
Miller DM, Youkhana I, Karunaratne WU, Pearce A. Presence of protein deposits on “cleaned” re-usable anaesthetic equipment. Anaesthesia 56(11):1069–1072, 2001.
Galinski M. Disposable laryngoscope blades do not interfere with ease of intubation in scheduled general anaesthesia patients. Europ J Anaesthesiol 20(9):731–735, Sep 2003.
Evans A. A comparison of the forces exerted during laryngoscopy using disposable and nondisposable laryngoscope blades. Anaesthesia 58(9):869–873, Sep 2003.
Fourneret-Vivier A. Single-use laryngoscope blade assessment. Annales Francais D’Anesthesie et de Reanimation 23(7):694–699, Jul 2004.
Twigg SJ. Randomized evaluation of the performance of single-use laryngoscopes in simulated easy and difficult intubations. Br J Anaesthesiol 90(1):8–13, Jan 2003.
Glutaraldehyde: Occupational Hazards in Hospitals. May 2001. National Institutes for Occupational Safety and Health. www.cdc.gov/niosh/2001-115.html.