Sometimes, it's easy to forget that even non-invasive, easy-to-reprocess instruments can pose a cross-contamination and infection risk. A sobering example: After two premature babies died at White Memorial Medical Center in December, Los Angeles public health investigators linked their deaths to contaminated laryngoscope blades. In published reports, the California hospital said that the outbreak of Pseudomonas aeruginosa, which sickened five other infants, was the result of a break in laryngoscope reprocessing protocol.

There's no need to sensationalize this unfortunate situation, but it is a reminder of just how difficult - and important - central sterile's job is. Further, it's a good opportunity to refresh your knowledge of laryngoscope blade processing.

A matter of standardization
The best way to sterilize such high-volume items as laryngoscope blades is systematically; that is, by standardizing personnel, procedure and product.

We've charged our anesthesia techs with reprocessing the blades. In fact, it's part of their clinical competencies and a task their supervisors monitor (in this case, the anesthesia department, working in conjunction with infection control). We're also in the process of buying both curved and straight laryngoscope blades in the same fiberoptic style. In addition to the stronger light fiberoptics provides, standardization breeds familiarity, and familiarity with the product makes reprocessing more efficient and fail-safe.

As for procedure, it's a fairly simple one (compared with, say, reprocessing flexible endoscopes), but we're going to break it down for you so you can see all the steps involved.

• After use, take the blades from the OR to the reprocessing area. There, you'll clean them in a combination of detergent and warm water, per the detergent manufacturer's instructions for dilution.
• The anesthesia tech (or whomever you designate to do the job) should then clean all areas of the blades, taking special care to scrub debris out of crevices with a soft brush, then he should rinse and dry them.
• A big key is doing a visual inspection for debris before putting each blade into the pan for transport to the automated reprocessor. No special connectors are needed for the blades to be high-level disinfected in the peracetic acid (or whatever disinfectant your particular machine uses).

Checks and double-checks
You can't steam-sterilize laryngoscope blades because of the light sources, and you don't need to sterilize them because they aren't invasive devices like scalpels. As a result, HLD is the industry standard for reprocessing these devices. If you use an automated reprocessor as we do, you must perform regular maintenance checks on the machine and change the disinfectant and the filters (documenting these actions) to prevent potential cross-contamination.

In addition, breakdowns in the OR often translate to breaks in infection protocol. Because of this, you should check batteries and bulbs on the laryngoscopes before each use - that way, you won't have to send for a new blade on the fly. You should also have back-up batteries and light bulbs in the room, plus two or three sizes of both curved and straight blades available for the anesthesia provider to pick from.

We believe our change to fiberoptic laryngoscope blades will help prevent these kinds of incidents, as there are no bulbs to come loose - so we expect the failure rate to be lower.

Get rid of the problem?
Cross-contamination posed by reusable laryngoscope blades in our outpatient surgery facility is decreased by the use of autoclavable laryngeal mask airways. In the main hospital, where intubations - and laryngoscopes - are common, we'd ideally like to move to disposable blades, a possibility we've just begun exploring. When you look at the number of laryngoscope blades used in a day, a week, a month, and the time you spend cleaning all of them, you may see that a large portion of your cost savings are being spent on the labor and materials for cleaning and disinfection.

Further, and perhaps more importantly, going disposable means that, after a procedure, you're left with a handle that reprocessing staff need only wipe down, which saves time and all but eliminates the possibility of cross-contamination and infection as a result of an improperly reprocessed blade.