Joint Commission Addresses Laryngoscope Blade Processing

The Association of periOperative Registered Nurses (AORN) is reporting that the Joint Commission has released a new standards-related FAQ that addresses the processing and storing of laryngoscope blades in perioperative-care settings.

The FAQ emphasizes that Joint Commission surveyors will evaluate processes related to laryngoscope blades to ensure that they are safe for use on the next patient. Surveyors will check that laryngoscope blades are processed via either sterilization or high-level disinfection, packaged in some way and stored in a way that would prevent recontamination. 

Many facilities may still only be hand-washing the blades and only performing low-level disinfection, according to Ramona Conner, MSN, RN, CNOR, manager of AORN standard and recommended practices. Sterilization or high-level disinfection of laryngoscope blades is not especially difficult. Facilities already have processes in place to perform this task. If the facility isnt already doing this, it should not be very difficult for them to begin including these devices in their system for reprocessing medical devices, she says.

According to the CDCs Healthcare Infection Control Practices Advisory Committee (HICPAC), 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.  Users are encouraged to read HICPACs document, "Guidelines for Preventing Healthcare-Associated Pneumonia." The last page of the guideline lists laryngoscope blades as semicritical items.  Recommendation IIIA1b (pages 57-58) states how semicritical items must be processed and packaged:

Whenever possible, use steam sterilization (by autoclaving) or high-level disinfection by wet heat pasteurization at >158oF (>70oC) for 30 minutes for reprocessing semicritical equipment or devices (i.e., items that come into direct or indirect contact with mucous membranes of the lower respiratory tract) that are not sensitive to heat and moisture (see examples in Appendix). Use low-temperature sterilization methods (as approved by the Office of Device Evaluation, Center for Devices and Radiologic Health, FDA) for equipment or devices that are heat- or moisture-sensitive (307;309;310;314;315). After disinfection, proceed with appropriate rinsing, drying, and packaging, taking care not to contaminate the disinfected items in the process (308;310). CATEGORY IA

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.
- Stored in a way that would prevent recontamination.  Examples of compliant storage include, but are not limited to, 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.

Laryngoscope handles are considered contaminated after use and must be processed prior to use on the next patient.  Most manufacturers suggest a low-level surface disinfectant be utilized on the surface of the handle, but processes vary by manufacturer.  As is the case with all medical devices, the manufacturers indications for use (IFU) must be followed.  Please also check your state for additional law or regulation; we are aware of at least one state that requires additional processing.