SUMMARY from Anaesthesia and Intensive Care 2003; 31:661-665.

Decontamination issues and perceived reliability of the laryngoscope - a clinician's perspective.

Yee KF.

Department of Anaesthesia, Westmead Hospital, Sydney, New South Wales.

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.

THE CASE FOR SINGLE USE LARYNGOSCOPES

Yee K. (1), Hales P.* (1)
(1) Westmead Hospital, Sydney, Australia

Anaesthetic procedures such as laryngoscopy may result in cross infection when the patients’ mucosal barriers are broken, and contaminated equipment is used.

Contamination of laryngoscope handles and blades by bacteria and blood has been well documented 1,2,3. Cases of cross infection attributed to laryngoscope use have been described 4,5,6. A British survey revealed a lack of uniform policy for decontamination of laryngoscopes, where only 22% of institutions autoclave routinely after every case 7. In light of prion diseases such as variant Creutzfeldt-Jakob disease reported in humans since 1996, Miller and colleagues found that 82% of reusable 'cleaned' laryngoscope blades had residual protein deposits 8.

Recently revised infection control policies by government and professional bodies acknowledge the need to sterilise laryngoscope blades after each use, and regular decontamination of the handles 9,10. However, repeated autoclaving of handles and blades lead to decreased reliability and a reduced functional life span. In a recent survey of Australian anaesthetists, 24.1% indicated the laryngoscope is always reliable whereas 75.9% indicated it to be intermittently so.

A solution to these problems is a new sterile packed single-use laryngoscope with a reliable bright illumination system and design features to limit cross contamination. A prototype of this instrument will be demonstrated.

1 Beamer JER, Cox RA. MRSA contamination of a laryngoscope blade: a potential vector for cross infection. Anaesthesia 1999, 54: 1010-1011.

2 Simmons SA. Laryngoscope handles: A potential for infection. Journal of the American Association of Nurse Anaesthetists 2000, 68: 233-6.

3 Phillips RA, Monaghan WP. Incidence of visible and occult blood on laryngoscope blades and handles. Journal of the American Association of Nurse Anaesthetists 1997, 65: 241-246.

4 Foweraker JE. The laryngoscope as a potential source of cross-infection. The Journal of Hospital Infection 1995, 24: 315-6.

5 Nelson KE, Warren D, Tomasi AM, Raju TN, Vidyasagar D. Transmission of Neonatal Listeriosis in a Delivery Room. American Journal of Diseases of Children 1985 139: 903-5.

6 Neal TJ, Hughes CR, Rothburn MM Shaw NJ. The neonatal laryngoscope as a potential source of cross infection. The Journal of Hospital Infection 1995, 30:315-7.

7 Esler MD, Baines LC, Wilkinson DJ, Langford RM. Decontamination of laryngoscopes: a survey of national practice. Anaesthesia 1999, 54: 582-598.

8 Miller DM, Youkhana I, Karunaratne WU, Pearce A. Presence of protein deposits on 'cleaned' re-usable anaesthetic equipment. Anaesthesia 2001, 56: 1069-1072.

9 Infection Control Policy, NSW Health Department, File No 01/336, Circular No 2002/45, Issued 11th April 2002, Section 9.

10 Infection Control in Anaesthesia, published by The Association of Anaesthetists of Great Britain and Ireland, London. November 2002

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Australian and New Zealand College of Anaesthetists Annual Scientific Meeting,
26-29th May 2007

Preliminary Evaluation of a New Disposable Laryngoscope

PURPOSE OF THE STUDY:
The aim of the Yeescope is to provide a new laryngoscope with a reliable, bright light for laryngoscopy and intubation, to improve hygiene practised around endotracheal intubation and minimise the risks of cross infection, and to improve the ergonomics of the laryngoscopy process during intubation. This paper reports on the preliminary evaluation of this new device within the same Department where laryngoscope problems were previously identified, and for which the Yeescope was developed to address.

METHODS:
Sixty Yeescopes were made available for general use in the Operating Suite. Respondents were to indicate if the listed features of the new device are worse than, the same as, or better than the current system of disposable metal ‘bulb-type’ blades coupled with reusable laryngoscope handles. Qualitative feedback was provided on an accompanying form handed out with each device.

RESULTS:
Of the 51 responses, 88.2% considered the brightness and 90.2% considered the reliability of the light as being better than the current system. Findings are summarised in the following table:

Assessment of Yeescope features by 51 respondents

CONCLUSION:

Results of the preliminary evaluation indicate many features of the Yeescope are better than those offered by currently available laryngoscope systems. Broader assessment is now required to confirm these findings.