Policy: Disinfecting Laryngscope Blades

Subject: Cleaning, High Level Disinfection, and Packaging of Laryngoscope Blades and Handles

Applicability:

o All Offor Health Sites

1. Policy:

After use, all laryngoscope blades and handles will be processed for cleaning, disinfecting,
testing, and packaging in a manner that ascertains the blade/handle to be ready for immediate
use.

Protocol

1. Procedure: Cleaning and High Level Disinfection Procedure for Blades:

Point of Use:

o Separate blade from handle and spray with neutral pH enzymatic pre-cleaner or

wrap in moist, quaternary ammonium isopropanol based germicidal wipe. Return

to CSR for subsequent cleaning and reprocessing.

Subsequent Cleaning:

o Remove blade from handle before cleaning. Tighten bulbs before cleaning.

o Rinse blade under cool running tap water until all visible soil is removed.
 o Immerse the blade in an enzymatic detergent and scrub thoroughly using a soft

bristle brush until all visible soil is removed. (Enzymatic detergent is prepared in

accordance with enzymatic cleaner manufacturer’s recommendations)

o Remove and rinse under cool running tap water to remove all residual detergent

o Dry blade with lint free, clean cloth

Autoclave Blade

o Use steam sterilization (by autoclaving) or high-level disinfection by wet heat

pasteurization at >158oF (>70oC) for 30 minutes for reprocessing semi-critical
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).
o 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).
o After disinfection, proceed with appropriate rinsing, drying, and packaging, taking
care not to contaminate the disinfected items in the process (308;310).

High Level Disinfection (Can also use on handle, depends on manufacture)

o Place cleaned blades in approved, high–level disinfectant solution that is prepared

and maintained according to manufacturer’s recommendation.

o Set the timer for 8 minutes per manufactures recommendations to allow for blade

exposure. Blades should be removed immediately following the 8 minutes.

o Thoroughly rinse blades by fully immersing in potable water.

 o Blades should then be thoroughly dried with lint free, clean cloth

o Making sure that lightbulb is fixed securely in blade; test the light bulb for

functionality by attaching blade to the laryngoscope handle. If the light from the

bulb is dull or does not wok it should be replaced with a new bulb and retested.

o Blades must be placed in a laryngoscope blade sleeve. A clean sticker should be

attached to the sleeve to hold the tab on the sleeve cover closed. Blade sleeve covers

should be used for all laryngoscope blades processed by the CS Department

o Blades belonging to surgery, OB and/or CSP must be separated so that they can be

returned to the appropriate department.

1. Cleaning and Intermediate Level Disinfection for Laryngoscope Handles:

Point of Use:

o Separate the blade from the handle and wrap handle in moist, quaternary

ammonium isopropanol based germicidal wipe to prevent drying

Subsequent Cleaning and Intermediate level disinfection:

o Using a quaternary ammonium isopropanol based germicidal wipe, clean all

exposed surfaces of the handle and end cap

o If necessary, brush with a dry, soft-bristled brush and re-wipe to loosen/remove

excessive visible soil

o After all soil is removed, using a new wipe, re-wipe exposed surfaces of the handle

and end cap and allow adequate contact time for disinfection as directed by

germicidal wipe manufacturer

o Handles are to be placed in the laryngoscope handle coverwith the connecting in

facing up. A clean sticker should be placed on the sleeve to hold the sleeve tab down.

o Handle sleeve covers are to be used for all laryngoscope handles processed in the CS

Department.

1. Testing:

o All laryngoscope blades and handles are to be tested prior to being returned to

customers, being put in intubation boxes,and/or being placed on code carts.

Corrective action, (replace batteries/bulbs) needs to be taken if blades/handles fail

testing

o Retest blade/handle once corrective action has been completed. If testing fails,

blade/handles should be removed from service and given to CSP Manager for

action.
 Reference

Infection Prevention and Control (CAMH / Hospitals)

Laryngoscopes – Blades and Handles - How to clean, disinfect and store these devices

Revised | October 11, 2013

JOINT COMMISSION

Laryngoscopes – Blades and Handles - How to clean, disinfect and store these devices

Devices such as laryngoscope blades and handles, may be exposed to potentially infectious material during indicated
use, and can become contaminated through direct contact with the patient's skin, mucous membranes, secretions and
blood. To reduce the risk of infection, the importance of standardizing the reprocessing and storage of the
laryngoscope’s blade and handle is emphasized (for non-disposable laryngoscopes).

Cleaning – Laryngoscope Blades

Equipment used for intubation such as laryngoscope blades should be properly cleaned using the process for
disinfection and sterilization of semi-critical items as designated by the CDC as “high-level” disinfection. Please
refer to the CDC and HICPAC document entitled Guidelines for Disinfection and Sterilization in Healthcare
Facilities, 2008.

In addition, the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) states laryngoscope
blades are “semicritical” items, which should be sterilized or subjected to high-level disinfection before reuse.” Read
CDC and HICPAC’s document entitled Guidelines for Preventing Healthcare-Associated Pneumonia, 2003.The last
page of the guideline lists laryngoscope blades as semi-critical items. Recommendation IIIA1b (pages 57-58) states
how semi-critical 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 semi-critical 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”

Cleaning – Laryngoscope Handles

Laryngoscope handles are considered contaminated after use and must be processed prior to use with the next
patient. Some manufacturers suggest a low-level surface disinfectant be utilized on the surface of the handle, while
others may recommend high level disinfection or sterilization. As is the case with all medical devices, the
manufacturer’s indications for use (IFU) must be followed. Also check with your state for additional law or
regulation; we are aware of at least one state that requires additional processing.
Storage

Laryngoscopes should be kept free from contamination until the time of use. Once opened, there is potential for
microorganisms to settle on the equipment the longer it remains open and unused. In addition, increased handling of
the opened unused blade increases the probability of contamination. Ensure that the storage area provides protection
against dust, moisture, temperature and humidity extremes.

Please refer to the CDC and HICPAC document entitled Guidelines for Disinfection and Sterilization in Healthcare
Facilities, 2008.

Storing laryngoscope blades individually eliminates the potential for contaminating multiple blades if packaged
together, and therefore having to reprocess several unused blades as opposed to the one that was used.

o An option would be to contain the individual blade in a closed plastic bag, placed in a clean storage location.

o If steam sterilized, a peel-pack may be used. When testing the light source and blade use:

o proper hand hygiene

o partially remove the blade from the package, attach to the light source, and test.

Following testing, insert the blade back into the package and return to a clean storage location (manipulation of the
blade onto the light source/handle can be tested without actually removing the blade from the bag or pack without
touching the blade itself).

Institute this practice to all areas where laryngoscopes are used. Examples are: code carts, anesthesia carts, and
difficult airway boxes or carts.

Joint Commission surveyors will evaluate processes related to laryngoscope blades/handles to ensure that they are
safe for use on the next patient. They will check that laryngoscope blades/handles are:

 For laryngoscope blades - processed via either high-level disinfection or sterilization.

 For laryngoscope handles – following manufacturer’s instructions-for-use for cleaning/disinfection

guidance.

 Packaged in some way. CDC and HICPAC guidelines do not specify the manner in which laryngoscope
blades should be packaged.
 Stored in a way that would prevent contamination. Examples of compliant storage include, but are not
limited to, a peel pack post steam sterilization, or containment within a closed plastic bag.

Examples of noncompliant storage would include unwrapped blades in an anesthesia drawer, as well as
unwrapped blades on top of or within a code cart.
• The organization demonstrates a consistent process applied to all appropriate areas as reflected by organization
policy and procedure.

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