Disposable Laryngoscope Blade Study Changes Minds of Users
Infection control is a widely discussed topic in the healthcare community, but is it making an impact? A 2011 study conducted by Melissa Dawn Machan from the University of North Florida indicates there is evidence of change. The study focuses on cleaning processes of anesthesia airway equipment and the perceptions of providers regarding the use of disposable laryngoscope blades.
With over 1.7 million people affected by nosocomial infections each year, according to the Centers for Disease Control and Prevention, stepping up infection control procedures is critical. Healthcare-associated infections (HAI’s) impact everyone from healthcare consumers to clinicians and cost over 6.7 billion dollars annually.
The relationship between contaminated anesthesia airway equipment and nosocomial infections is clear, but difficult to prove. Blood offers a viable environment for pathogen growth, so when trapped on reusable airway equipment, it provides a transport mechanism from host to host. This puts laryngoscopes at the top of the list for possible sites of contamination.
The Study Concept
Machan’s study looked specifically at how anesthesia practitioners felt about using disposable laryngoscope blades. How often they used them and what complications they encountered along the way.
The intubation process can be a bloody one due to the manipulation of a patient’s airway. Studies suggest that the current cleaning process for laryngoscopes is ineffective and a HAI concern. Even with enhanced infection control guidelines, patients and healthcare workers may be exposed to blood, and, possibly infection.
Not all anesthesia providers are satisfied with reusable blades because of the cleaning process. Disposable blades offer better infection control, lower costs and improved fiberoptic lighting.
Machan focused on one large South Florida hospital for her study. All of the anesthesia providers at this facility agreed to participate. The practitioners completed a one-page questionnaire discussing what they know about disposable laryngoscopes blades prior to the study. After completing the questionnaire, each one was given an article to read regarding infection control practices of laryngoscope blades.
As part of the study, the hospital agreed to keep disposable laryngoscope blades stocked in the operating room at a cost of 4.35 dollars each, which was charged to the patient. This gave all the anesthesia providers at the facility the option to use disposable blades for three months.
The Study Participants
There were a total of 12 anesthesia providers participating in this study, all working in the field for over one year. Seventy-five percent of the participants had been in practice for over 10 years.
- 58% treated only adults
- 25% treated children
- 17% treated woman in obstetrics
All had previously used some type of disposable blade before the study.
- 33% used them regularly
- 33% used them about 75 percent of the time
- 17% used them 50 percent of the time
- 17% used them 25 percent of the time
Some of the providers, approximately 25%, said poor performance was their main reason for not using disposable products more often. They claimed flexibility, limited view and environmental issues were their primary concerns. Only 8% of the participants claimed lack of availability factored into their use of the disposable laryngoscope blades.
The Study Results
The study methodology consisted of inventorying the disposable blades at the start of the project and again at the three month milestone. In addition, all anesthetics requiring intubation on adults were counted during the three month period. By correlating this data, the investigator calculated the number of intubations done using a disposable blade.
The study attempted to answer specific questions about the practitioner’s experience using disposable blades. The first question regarded ease of use. Prior to the study, 83% of the participants stated the blades were easy to use. In the interview after the study, 92% percent said they were easy to use. The conclusion was this study did not have a significant impact on the provider’s perception regarding ease of use.
Performance of the blade was the second criteria examined in this study. Prior to the intervention, 60% of the providers listed performance of disposable blades as an issue for them. After the 3-month study, only 25% still made this claim. When asked specifically what complications they encountered, 50% said none. Others listed:
- Bulky size
The third segment of the study investigated the actual use of the blade. One week prior to the start of the study, there were 30 general anesthetics that required intubation. Of that 30, 12 utilized a disposable laryngoscope blade.
The second month of the study showed a significant increase in the use of disposable blades. Of the 48 intubations done during the first week of the second month, 31 of them included the use of a disposable blade. That is 65% of the intubations as opposed to only 40% before the study began.
The first week of the third month included 24 intubations. The providers reported 15 utilized a disposable laryngoscope blade. That is 63%, showing the increased use continued into the third month of the study. Overall, the use of the blades increased significantly as a result of this study.
Although the providers didn’t see a big difference in the ease of use of disposable laryngoscope blades, they increased the number of times they used them with this study. There was a 23% increase in use over the three month period.
After the study completed, a number of the anesthesia providers stated they felt disposable laryngoscope blades were easy to use and a practical option. Of those who felt they were difficult to use prior to the study, 50% had changed their minds.
The reasons for not using a disposable blade changed, as well. Prior to the study, almost 60% of the providers who did not like to use them listed performance as the reason. After three months, only 25% listed performance as being a concern. This indicates that the providers became more comfortable with the disposable blades once they started using them.
Many were still concerned about availability issues, specifically would the right sized blade be available to them when needed. Many stated a Macintosh 4 blade or Miller blades were the best choice for some adult intubations, but they only had Macintosh 3 blades available as disposable products. At least one of the providers stated they didn’t use any disposable blades during the study for this reason. A practitioner that works only in pediatrics would not have the right blade available for the study.
Overall, the study increased the use of disposable blades in this facility, impacting patient safety and improving infection control. There were many limitations for the study, such as only working with a small number of participants, but it does show that practitioners are open to change given the opportunity.
The investigator recommends medical facilities make the change to disposable laryngoscope blades, providing the old-school metal blades only for difficult intubations or when the proper blade is not available. Hospitals can improve the effectiveness of the transition to disposable blades by expanding to different sizes, as well. They should include the Macintosh 3 and 4 blades and the Miller sized 2, 3, and four in their inventories.
Since this study was published new options for entirely single-use laryngoscopes (includes blade, handle, and light source) have come to market. For example, OBP Medical’s SURE-SCOPE offers unmatched blade strength and the brightest single-use LED light source on the market today. In addition, an entirely single-use device, like SURE-SCOPE, eliminates the risk of cross-contamination from poorly cleaned reusable devices including reusable laryngosocpe handles.