By Nancy Chobin, RN, AAS, ACSP, CSPM
Q: Recently our facility was cited for disinfected laryngoscope blades that were found unprotected from re-contamination in storage. What is the recommended practice for these items?
A: This question has many implications. CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) says laryngoscope blades are “semicritical” items, which are defined as, “Items that directly or indirectly contact mucous membranes of the respiratory tract. They should be sterilized or subjected to high-level disinfection before reuse.” After they are cleaned according to the manufacturer’s IFU, there are several options for processing laryngoscope handles and blades. Many laryngoscope blades can be high-level-disinfected. If high-level disinfection is used (check the manufacturer’s IFU for compatible chemicals), the blade must be protected from recontamination after processing. One way of accomplishing this is to place the blade in a zip-lock bag and then apply a “Clean Not Sterile” label to the top of the bag. (Make sure that you clean your hands first.) If anyone opens the bag, the label will be damaged indicating the blade could be contaminated. At some facilities, laryngoscope blades are sterilized, which is acceptable but not necessary (CDC, 2003). Packaging blades requires the package to be opened if nursing must test the laryngoscope bulb on the blade. This results in a blade being replaced inside an open paper-plastic pouch. The opened pouch does not protect the blade from contaminates.
The Joint Commission has advised that laryngoscope blades should be packaged in some way. According to the JC alert, “Joint Commission surveyors will check to ensure that blades are stored in a way that will prevent recontamination. Examples of noncompliance include unwrapped blades in an anesthesia drawer and unwrapped blades on top of a code cart.” After cleaning and high-level disinfection, laryngoscope blades should not be placed in a paper–plastic pouch for storage. Paper–plastic pouches should only be used if the blades will be sterilized (otherwise, it could be wrongly assumed that the blades are sterile).
Laryngoscope handles are considered contaminated after use and must be processed before use on the next patient. Depending on the handle manufacture, the recommended processing could include low level disinfection, sanitization, high-level disinfection or sterilization to decontaminate handles. As for all medical devices, the manufacturers' IFU must be followed. It should be noted that state regulations might require additional processing. Once cleaned and disinfected or sterilized, the handles should be packaged (e.g., in a Ziplock bag) to prevent recontamination. The package should be labeled “Clean Not Sterile” or with similar wording to advise the end user that the handle has been reprocessed.
Joint Commission surveyors will evaluate processes related to laryngoscope blades to ensure that they are safe for use on the next patient. They will check that laryngoscope blades are processed via either sterilization or high-level disinfection; packaged in some way (HICPAC guidelines do not specify the manner in which laryngoscope blades should be packaged); and stored in a way that would prevent recontamination. Examples of compliant storage include a peel pack post steam sterilization (long-term) or wrapping in a sterile towel (short-term). Examples of noncompliant storage would include unwrapped blades in an anesthesia drawer, as well as unwrapped blades on top of a code cart.
It is recommended to share this information with any departments performing processing of laryngoscope handles and blades to ensure compliance.
Nancy Chobin, RN, AAS, ACSP, CSPM, is a sterile processing educator and consultant.
AAMI ST-79, Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities, 2013.
Joint Commission Alert, CAMH/Hospitals. Oct. 24, 2011. Laryngoscope Blades and Handles.