Decontamination of laryngoscope blades: is our practice adequate?

Background : The laryngoscope has been identified as a potential source of cross-infection, because of blood and bacterial contamination. In India, there are no guidelines for cleaning and disinfection of anesthesia-related equipment. Practices for decontamination of laryngoscopes vary widely and in most healthcare institutes, laryngoscope blades are re-used after cleaning with tap-water. Materials and Methods: We prospectively compared two techniques for decontamination of laryngoscope blades - a) washing with tap-water and b) washing with tap-water followed by disinfection by immersing in 5% v/v (volume/volume, 1:20 dilution) aldehyde-free biguanide agent for 10 min. We calculated the cost-effectiveness of using 5% v/v aldehyde-free biguanide agent for disinfection of laryngoscopes. We also conducted a survey to assess the decontamination practices in other Indian hospitals. Results : Overall bacterial growth was 58% (29 out of 50 blades) after tap-water cleaning (of which 60% were pathogenic organisms) versus 3.4% (one out of 29 blades) after tap-water cleaning followed by immersion in disinfectant (all of which were commensals). The cost of disinfection with biguanide was Indian Rupees 1.13 (20 US cents) per laryngoscope. Most hospitals in India do not have guidelines regarding laryngoscope decontamination between uses, and cleaning with tap water is a commonly used method. Conclusion : Cleaning of laryngoscope blades with tap-water is a commonly used but inadequate method for decontamination. Washing with tap-water followed by disinfection with 5% v/v aldehyde-free biguanide for at least 10 min is an effective and inexpensive alternative. National guidelines for the decontamination of anesthesia equipment are necessary.