September 16, 2013 — In 2007 the Health and Human Services Agency Department of Health Services for the state of California advised facility administrators and infection prevention and control professionals, by way of a letter, of the risk of disease transmission associated with the inadequate reprocessing of semi-critical instruments.

Along with providing specific instructions for reprocessing the blade and handle of a rigid laryngoscope, this letter by the state of California also provides the details of a number of documented instances of infection-control breaches, namely, of:

1.  an outbreak of Pseudomonas aeruginosa in an acute care hospital linked to a medical facility’s failure to high-level disinfect rigid laryngoscopes used to intubate neonates. The manufacturer of these laryngoscopes requires them to be cleaning followed by either high-level disinfection or sterilization to prevent disease transmission;

Click here to read the original letter by the State of California’s Health and Human Services Agency Department of Health Services.

2.  an acute care hospital’s similar failure to high-level disinfect bougies (solid non-lumened silicon instruments used to dilate the esophagus) after each clinical use as required by their manufacturers;

3.  an acute care hospital’s similar failure to high-level disinfect its flexible laryngoscopes used during difficult intubations; and, among other lapses,

4. an outbreak of E. coli respiratory tract infections in an acute care hospital linked to the use of a damaged transesophageal echocardiography (or, “TEE”) probe that was frayed and otherwise damaged.

These respiratory tract infections are discussed in more detail in Dr. Muscarella’s related article, “Escherichia coli Infections Linked to a Contaminated TEE Probe.”

Recommendations

This letter, or health alert, by the state of California provides a number of important recommendations that are provided herein for study, review, and inclusion in a medical facility’s appropriate policies and procedures for reprocessing rigid laryngoscopes.

Recommendations for the reprocessing of other types of reusable semi-critical instrumentation (other than rigid laryngoscopes) were not provided in this letter by the State of California’s Health and Human Services Agency Department of Health Services.

Instructions for the proper cleaning and disinfection of these other types of instruments can be obtained by contacting their manufacturer or by performing a search of this blog’s many articles.

For example, this blog contains the aforementioned article “Escherichia coli Infections Linked to a Contaminated TEE Probe,” which provides specific recommendations for preventing disease transmission during TEE.

 Actual practices for reprocessing should be observed. When reprocessing changes are indicated, stake-holding staff should be involved in the improvement process. — State of California’s Health and Human Services Agency Department of Health Services.

Similarly, this blog features articles that provide recommendations for the reprocessing of sheathed “ENT” laryngoscopes, skin electrodes, the GI endoscope’s MAJ-855 auxiliary water tubearthroscopic shaver handpieces, and surgical instruments potentially contaminated with prions, the causative agent of “CJD,” to name a few.

Click here to read Dr. Muscarella’s related blog “The Reprocessing of Sheathed “ENT” Endoscopes and Cystoscopes.”

A number of additional recommendations are provided:

1.  Review the classification of medical devices and the different levels of disinfection. (Although important, this specific recommendation is not explicitly provided in this state of California’s letter.)

Click here to read Dr. Muscarella’s related article about device classifications and the different levels of disinfection.

2. Routinely perform internal and external audits of the medical facility’s practices, to ensure adherence to the specific recommendations provided in this blog. (Although important, this specific recommendation is not explicitly provided in this state of California’s letter.)

3.  According to this letter by the state of California, “flexible and rigid laryngoscopes — both blades and handles, are classified as semi-critical devices, and therefore require (a) cleaning and (b) high-level disinfection or sterilization. We recommend high-level disinfection or sterilization regardless of whether a protective barrier or sheath is used during the procedure, since the laryngoscope may be contaminated during use or removal of the sheath.”

Quaternary ammonium products and other cleaner/disinfectants, labeled to achieve intermediate-level (or low-level) disinfection, including alcohol or other disinfectant wipes, should never be used for reprocessing flexible and rigid laryngoscopes or other semi-critical devices. — State of California’s Health and Human Services Agency Department of Health Services.

4. Also according to this letter by the state of California, “the laryngoscope should always be dried to prevent contamination after reprocessing.”

Also read Dr. Muscarella’ s related article, “Reprocessing the Handles of Rigid Laryngoscopes.”

5.  Further, “the laryngoscope should be examined for visible evidence of damage and removed from use if damage is observed or suspected.”

6. Referencing this blog’s author, this health alert by the state of California writes that “the following recommendations have been adapted from (one of Dr. Muscarella’s own publications entitled) “Guidelines for reprocessing rigid laryngoscopes” — click here to download a copy of Dr. Muscarella’s guideline.

To our knowledge (Dr. Muscarella’s) are the only published guidelines specific to reprocessing rigid laryngoscopes. They may be used to develop a facility specific policy and procedure for reprocessing laryngoscopes, in conjunction with the reprocessing instructions provided by the laryngoscope’s manufacturer, which may require additional reprocessing steps. — State of California’s Health and Human Services Agency Department of Health Services.

Article by Lawrence F Muscarella, PhD; posted: 9/16/2013, Rev A.

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