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Over the past few months we’ve received several requests for disposable laryngoscope blades.  A lot of it has to do with the JHACO recommendations for sterilizing the blades.  As I’ve spoken with clinicians and administrators, let me share some of the anecdotes.  To start, some customers take the JHACO recommendation as just that- a recommendation.  Others believe that the recommendation is simply a precursor to a mandate and want to get prepared before it happens. 

 

 

“What problem are we really trying to solve here?”

 

According to some administrator’s we’ve spoken to, the issue is Hospital Acquired Infection due to cross contamination traced to Laryngoscopy.   Focusing in on routine laryngoscopies for the moment, there are a few solutions out there.

 

 The obvious one is to follow the JHACO recommendation to sterilize/package the blades and wipe down the handles with a germicide before the next use.   Blades are considered semi-critical and handles are considered.  See the JHACO details here: (http://www.jointcommission.org/mobile/standards_information/jcfaqdetails.aspx?StandardsFAQId=386&StandardsFAQChapterId=21) 

 

Alternatively, some facilities are exploring disposable options:  disposable blades that come sterile and wrapped, disposable handle/blade sets that have a reusable battery/bulb insert, condom-like sheaths that roll onto a reusable laryngoscope handle.   So let’s explore some options….

 

“If I go to disposable blades, what’s this going to cost me?”

  Some hospitals have share with me the cost to clean a laryngoscope blade- it ranges from $4 to $8, not including the cost of the blade.  The lower end is the time and material if the blade is cleaned in a workroom near the OR, the higher end, if the blades need to be sent to Central Supply.  Get rid of the cleaning of blades, and the hospital has at least $4 per routine intubation to put towards a more compliant solution. 

 

“What are my clinical options for routine Laryngoscopy?”

In the disposable blade arena, there some common options:

 

Metal Fiber Optic:  Sterile and disposable, durable.  The light will not be as good as a reusable blade but most clinicians have found it to be sufficient for routine intubations.  Cost, under $5

Plastic Fiber Optic: Same as the metal.  However the big issue with the plastic blades that I’ve heard is the concern of torque or breaking.  Some argue that if that much force is needed, then chose another intubation tool.  Others tell me it’s not worth the risk.  Some say that they like metal better.  The light issue is the same as with the metal.  Cost, under $3

Metal Conventional: In a conventional blade, the light bulb is in the blade whereas in Fiber Optic, the light source is in the handle.  The Metal Conventional Blades are sterile, disposable, durable, and light that is as good as fiber optic according to the clinicians who have tried them.  The objection has been ‘…I have fiber optics now and don’t want to mix them’.  The handles are inexpensive- less than $15 and the blades are under $5. 

 

For handles, the recommendation is to simply wipe down the handle before the next use.  Alternatively, the handles can be sterilized of course, a disposable handle with reusable power/light is available, or a sheath can be rolled onto the handle. 

 

“What constraints do I need to consider with disposable blades?”

 

Laryngoscopies are done in the OR and anywhere that there is an emergency airway cart so it follows that the same blade processing protocol applies to these as well as airway bags, ER, and EMT.  Different departments, though, have different protocols and even different preferences on brand or even intubation aids.  

 

“What other options do I have?”

 

Glidescope®, Airtraq Avant®, and other manufactures of difficult intubation products have a disposable sleeve option.  They vary greatly in price, ease of use, and preference. 

 

 

Keywords: disposable blades, disposable laryngoscope, infection control, disposable metal, disposable plastic, intubation, JHACO




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