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

Abstract

ObjectivesTo 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.MethodsOne 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.ResultsOne 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).ConclusionsProtocols 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.

Contamination and Disinfection of Rigid Laryngoscopes: A Literature Review

“…In a descriptive study to identify bacterial contamination rates of laryngoscope blades and handles stored in emergency carts, Choi et al obtained microbiological cultures from 148 patient‐ready laryngoscope blades and 71 laryngoscope handles from two tertiary teaching hospitals in Gyeonggi and Chungcheong Province, Korea. The laryngoscope blades had been processed by manual chemical HLD.…”

“…The laryngoscope handles had been disinfected by wiping with germicidal wipes of a type not specified by the researchers. Notably, the researchers also did not specify whether the laryngoscopes had been manually cleaned before disinfection; however, they did specify that the laryngoscopes were “ready for patient use.” (p160) After disinfection, the laryngoscope blades were placed in clean but unsealed sterilization pouches or left unpackaged with the handles. The researchers did not describe how the handles were stored.…”

“…The researchers did not describe how the handles were stored. The researchers obtained positive cultures from the tops of four laryngoscope handles (5.6%), the knurled surfaces (ie, surfaces with small ridges and grooves) of 20 handles (28.2%), and the blades of 27 laryngoscopes (18.2%) . They found the contamination rate of the knurled surface of the laryngoscope handles was significantly higher than the contamination rate of the top of the handles ( P < .001).…”

“…The researchers suggested that there was a need for professional guidelines for disinfecting laryngoscope blades and handles, and a need to improve the design of laryngoscopes to decrease handle contamination. They recommended using single‐use laryngoscopes to prevent transmission of infection from laryngoscopes to patients or health care providers …”

“…However, health care team members may unknowingly transfer microorganisms directly from the blade to the top of the handle or indirectly through the knurled surface of the handle . It is possible for the top of the handle to contact the patient's oral cavity during intubation . Although the knurled surface of the handle provides friction to help prevent the health care provider's hand from slipping while holding onto the handle and performing intubation, it is difficult to clean, and residual blood or microorganisms may remain on the handle if not effectively cleaned and disinfected …”