Reassessment of the risk of healthcare-acquired infection during rigid laryngoscopy.

Abstract

Inadequate reprocessing of rigid laryngoscopes has been linked to nosocomial outbreaks with associated morbidity and mortality. Last year an outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit was responsible for multiple infections and colonisations, and at least two infant deaths. An investigation of this outbreak identified contaminated rigid laryngoscopes as its source, demonstrating that inadequate reprocessing of rigid laryngoscopes remains a current public health concern. This article revisits and reassesses the risk of healthcare-acquired infection during rigid laryngoscopy and establishes the minimum reprocessing requirements for blades and handles of rigid laryngoscopes. Several potential risk factors for microbial transmission are identified and discussed, including the publication of inconsistent reprocessing guidelines for rigid laryngoscopes. Concern about guidelines that recommend low-level or intermediate-level disinfection of rigid laryngoscopes is expressed. The use of a sterile disposable sheath to cover the rigid laryngoscope and minimise the risk of contamination is also discussed. Regardless of whether a sheath is used during the procedure, thorough cleaning followed by high-level disinfection and drying of the instrument is recommended to prevent microbial transmission.