Sterilization of Laryngoscopes: Ensuring Safety in Anesthesia Practices

Microbiology Assignment Regarding the Sterilization of Laryngoscopes Inquiry

Task: Compose a report on a microbiology assignment that critically evaluates the notion of laryngoscope sterilization.

Response

Preface

A laryngoscope is a device often used by anesthesiologists during general anesthesia and endotracheal intubation procedures. This apparatus has been recognized as a significant contributor to cross-infection. The Centers for Disease Control classify these as semi-critical goods, indicating that they need chemical disinfection prior to use. Numerous viruses, such as Human Immunodeficiency Virus and Hepatitis B Virus, have been detected on this equipment, with HPV recognized for its ability to persist on surfaces for up to six days (Chawla et al., 2016). Established protocols exist to regulate the cleaning and disinfection of clinical equipment. Recent polls reveal inadequate adherence to this approach, rendering it useless in avoiding contamination.This research seeks to identify the reasons behind the perceived ineffectiveness of the decontamination process and to propose potential improvements.

Review of literature

Laryngoscopy entails direct contact between the laryngoscope with saliva, mucosal membranes, and blood, hence posing a significant infection risk for individuals undergoing the procedure. The paper by Machan (2012) indicates that while anesthesia experts recognize the possibility of cross-infection, the adoption of precautionary measures has not been accepted. The text indicates that while patients exhibit no signs of infection, hardly 24 percent of anesthesiologists implement the necessary measures, but a substantial 88 percent exercise caution in the presence of an HIV-positive patient (Rutala & Weber, 2016). Studies indicate that blood on the equipment is not always visible to the unaided eye. In a test conducted to detect concealed blood in the equipment, 86% of the samples exhibited the presence of blood discharges.

Dias and Karnik, 2017. Since that time, several tests have been used to detect blood in airway apparatus.
The interaction with the mucosal membrane categorizes the equipment as semi-critical, necessitating rigorous cleaning to eliminate all pathogens except bacterial spores. The CDC recommends pasteurization in hot water above 80°C for 30 minutes, or exposure to a sterilizing agent for a duration of 10 to 45 minutes (Sherman & Hopf, 2018). The most effective decontamination procedure is autoclaving, since it also prevents bacterial proliferation. The compounds endorsed by the Food and Drug Administration include glutaraldehyde, hydrogen peroxide, ortho-phthalaldehyde, and peracetic acid combined with hydrogen peroxide (Merry et al., 2019).

Proposition

This article posits that the presence of blood on laryngoscope blades necessitates thorough cleaning to enhance safety for both the patient and the anesthesiologist.

Approaches

A study conducted in India by Dias and Karnik (2017) included professional anesthesiologists responding to inquiries on the cleaning protocols used on laryngoscopes prior to their utilization. This poll was conducted by questionnaires sent to professionals at a conference who consented to participate. One hundred fifty anesthesiologists agreed to participate in this poll.

Deliberations

The study conducted by Dias and Karnik (2017) reveals that at least 28% of the anesthesiologists surveyed were unaware of the proper cleaning methods for used laryngoscope blades. Moreover, just 46% of individuals sanitized the handle after each use, while the remainder did so only intermittently, namely when fluids and blood were visibly apparent, or not at all. Notably, only 19% of these medical professionals were aware that soaking laryngoscope blades in disinfectants is the appropriate method for decontamination after use (Dias & Karnik, 2017). This study conducted in India revealed the absence of a particular methodology for the cleaning of laryngoscopes. Although the prevailing consensus indicated that reusable equipment required cleaning and disinfection, the practices of professionals in healthcare facilities did not align with this view. In a separate study, Machan (2012) asserts that the majority of practitioners choose single-use gadgets over reusable ones.This indicates that a bias against reusable devices has already been established by the individuals responsible for using them in therapy applications. Both the blade and the handle may facilitate cross-infection and must be cleaned, since the contaminated tip contacts the handle while the device is folded and not in use.The paper advocated for the disinfection of equipment, use of disposable instruments, and the development of innovative handle designs to minimize touch points. The laryngoscope handle is designed to enhance grip, although it promotes the accumulation of dirt. The blade is intricate, with several detachable components that facilitate the buildup of dirt. This design suggests that infections are prone to collect on this equipment, and any errors in handling, cleaning, or storage may facilitate the persistence of these harmful bacteria.

Moreover, inadequate handling may result in infection despite prior cleaning. A sterile method for administering anesthetic has been developed to minimize the danger of infection (Machan, 2012). This entails donning two pairs of gloves before to induction and thereafter removing the gloves meticulously to ensure the laryngoscope stays inside the glove. This procedure is designed to prevent the laryngoscope from coming into touch with other instruments or surfaces. Another approach involves use a tape-secured plastic bag, into which the blade is inserted post-use to prevent infection.

Machan's (2012) research indicates that the protocol for cleaning and sanitizing the equipment requires revision. The equipment should be cleaned prior to immersion in disinfectant to enhance decontamination efficacy; however, this procedure is rarely consistently followed. The CDC lacks a standardized protocol for cleaning this equipment. It provides recommendations while urging users to adhere to the manufacturer's instructions during decontamination. When this cleaning procedure is not seen as essential, less action may be taken to mitigate rampant cross-infection among patients. The recommended procedure is to clean, rinse, disinfect, and dry.

Machan's (2012) investigation revealed no indication of harmful chemicals on the laryngoscope blade and handle. Nonetheless, given that pathogens like viruses may persist on dry surfaces for over a week, the associated danger must be acknowledged and addressed. Research conducted by Sousa et al. (2013) identified infections, including Streptococcus pneumoniae, on laryngoscope blades prepared for use and in deceased newborns on whom these instruments had been used. The investigation indicated that the professionals recognized that the cleaning procedures used were inconsistent with those advised by authoritative organizations. The medical workers said that they would not use the recently sanitized equipment employed on patients for their own oral usage. This information suggests that the cleaning procedure is inefficient not due to erroneous techniques, but because the suggestions are either disregarded or not meticulously adhered to.Dias & Karnik (2017) discovered that the predominant method for cleaning laryngoscopes was washing with detergent, contrary to the CDC's guideline of soaking in hot water or disinfection.

Conclusion

Although several papers contend that the use of single-use laryngoscopes significantly reduces cross-infection in anesthesia, it is essential to also consider environmental conditions. The pollution generated by single-use medical equipment will undermine the beneficial effects they are intended to provide, hence contributing to more diseases. Consequently, according to the manufacturer's disinfection guidelines is preferable to ensure that the reuse of this equipment does not provide an infection risk to patients.The danger of infection from reusable airway devices arises from inadequate cleaning. Moreover, using the equipment carefully to prevent contamination will diminish the risk of cross-infection.

References

Chawla, R., Gupta, A., Gupta, A. and Kumar, M., 2016. Laryngoscope decontamination techniques: A survey. Journal of anaesthesiology, clinical pharmacology, 32(1), p.99.

Dias, R. & Karnik, P., 2017. Disinfection of laryngoscopes: A survey of practice. Indian Journal of Anaesthesia, 61(3), pp. 245-249.

Machan, M., 2012. Infection Control Practices of Laryngoscope Blades: A Review of the Literature. AANA Journal, 80(2), pp. 274-278.

Merry, A. et al., 2019. The SAFE-T Summit and the International Standards for a Safe Practice of Anesthesia Safe Practice of Anesthesia. The official journal of the anesthesia patient safety foundation, 33(3), pp. 69-104.

Rutala, W.A. and Weber, D.J., 2016. Disinfection, sterilization, and antisepsis: An overview. American journal of infection control, 44(5), pp.e1-e6.

Sherman, J.D. and Hopf, H.W., 2018. Balancing infection control and environmental protection as a matter of patient safety: the case of laryngoscope handles. Anesthesia & Analgesia, 127(2), pp.576-579.

Sousa, A. N., Levy, C. & Freitas, M., 2013. Laryngoscope blades and handles as sources of cross-infection: an integrative review. Journal of Hospital Infection , Volume 83, pp. 269-275.

Van Wicklin, S.A., 2019. Contamination and Disinfection of Rigid Laryngoscopes: A Literature Review. AORN journal, 110(1), pp.49-59.