sterilizing laryngoscope blades

[m32b]

doing an outside rotation now...to my dismay we have to clean our own blades after use....to my shock we were instructed to do so using just soap and water in the scrub sink!

anybody else have to do this, and in particular, this way.

any other suggestions how to do this in a more sanitary fashion.

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[VolatileAgent]

(best militarymd impersonation)

"who told you that?"

seriously, we have our techs clean them in a similar manner in the workroom. they use a santizing scrub and then the blades are air-dried. if cleaned properly, there is no concern about transmission of infection.

in other words, you don't demand to see proof that the fork and spoon you're eating from have been autoclaved when you're at that fancy restaurant down the street, do you?

 

[2ndyear]

Our techs do it that way too, soap and water in the sink. They use a dedicated 'equipment' sink and not the scrub sink though, but they go right in the with the fiberoptic bronchoscopes, echo probes, intubating LMA's. Since intubation isn't a sterile procedure the stuff doesn't need to be autoclaved. It's not even a clean procedure, pretty gross sometimes.

 

[jwk]

Surely you jest. Soap and water? Is that really what you'd like used on you after the previous HIV+ patient?

Our blades are scrubbed with those little hibiclens or betadine scrub brushed the surgeons use when scrubbing, then AUTOCLAVED like surgical instruments.

 

[Bertelman]

Yep, this is (somewhat) the right way. I'd also question the use of the scrub sink, and some clarification on the "soap" used would be nice. As mentioned, there should be a dedicated dirty sink, and there are special solutions that are cidal that should be used. Autoclave is not neccessary (see below). From my experience, there is a special solution that the blade would soak in for ~30 minutes, at which point it would be scrubbed, rinsed, then air-dry. Soap, rinse then dry would most likely destroy any HIV on the blade as long as all tissue remnants are removed. I'd be more worried about Hep.

Otherwise, use this forum as your own personal knowledge base. I wouldn't mention this on your evaluation of the away rotation.

From ASA:
B. EQUIPMENT REQUIRING HIGH-LEVEL DISINFECTION
Recommendation
Equipment that will contact mucous membranes but would not ordinarily penetrate body surfaces should be free from contamination but need not be sterile.

Rationale and Interpretive Statements
This equipment would include laryngoscope blades, oral and nasal airways, face masks, breathing circuits and connectors, self-inflating resuscitation bags, esophageal stethoscopes and esophageal/nasopharyngeal/rectal temperature probes (Spaulding's "Semi-critical" items).

p.s. does kind of suck that you have to do it. Are there no techs?

 

[VolatileAgent]

Surely you jest. Soap and water? Is that really what you'd like used on you after the previous HIV+ patient?

more than enough to kill hiv. now, if you'd said pseudomonas...

Our blades are scrubbed with those little hibiclens or betadine scrub brushed the surgeons use when scrubbing, then AUTOCLAVED like surgical instruments.

overkill. waste of resources. not something that needs to be done each time.

 

[zippy2u]

Reminds me of the time that the administrative bean counter CEO gave the anesthesia dept. notice that the hospital was eliminating the anesthesia tech job because the hospital was in the "era of cost containment". Everybody was going to have to wash blades and change out circuits and all that crap. Job paid about $8-9/hour-- those cheap bastaards. I just started slowly throwing away shiit like anesthesia drugs, blades, esophageal steths, soda lime, batteries and pretty much anything related to anesthesia. Months passed... The materials management and pharmacist squirrels were scratchin' their heads bigtime. I nonchalantly suggested in passing that the anesthesia tech kept everything in check and up to snuff. They reestablished the anesthesia tech position and things stopped disappearing. Moral of story-- Ole Zip doesn't do blades. Regards, ---Zippy

 

[Bertelman]

Moral of story-- Ole Zip doesn't do blades. Regards, ---Zippy

 

[crockett]

Reminds me of the time that the administrative bean counter CEO gave the anesthesia dept. notice that the hospital was eliminating the anesthesia tech job because the hospital was in the "era of cost containment". Everybody was going to have to wash blades and change out circuits and all that crap. Job paid about $8-9/hour-- those cheap bastaards. I just started slowly throwing away shiit like anesthesia drugs, blades, esophageal steths, soda lime, batteries and pretty much anything related to anesthesia. Months passed... The materials management and pharmacist squirrels were scratchin' their heads bigtime. I nonchalantly suggested in passing that the anesthesia tech kept everything in check and up to snuff. They reestablished the anesthesia tech position and things stopped disappearing. Moral of story-- Ole Zip doesn't do blades. Regards, ---Zippy

That is great. The passive aggressive approach works every time. When I was a resident the lazy anesthesia techs tried to dump that job on us. They did nothing other than hang out in the OR lounge watching TV. You just had to be firm and refuse and refuse to waste your time doing that crap.

 

[VolatileAgent]

When I was a resident the lazy anesthesia techs tried to dump that job on us.

lazy anesthesia techs? man, where did you train? our techs are awesome, save for one or two, and are always there to help out. i've never (personally) had a problem with not getting something when i need it, or having an extra pair of hands to set-up monitors and hand me stuff on a big case (ie., art lines, cvps, swans, etc.). they come to traumas with us. a great tech just knows what you want next, and i've been in many situations where i start to ask for something, turn my head, and it's already there in front of me in their hand.

sorry you had a bad experience. sounds like a management problem to me.

 

[pratik7]

I worked as an anes tech for a couple of years before i started med school. I cant believe that yall just wash them with soap and water. We would wash them with soap, chemically sterilize for 15 mins, and rinse. Same for the scope. In addition, things that could be autoclaved, like LMAs, were autoclaved.

Soap and water sounds really shady

 

[Conflicted]

We use the disposable metal blades with our fiberoptic scopes.

 

[rn29306]

Reminds me of the time that the administrative bean counter CEO gave the anesthesia dept. notice that the hospital was eliminating the anesthesia tech job because the hospital was in the "era of cost containment". Everybody was going to have to wash blades and change out circuits and all that crap. Job paid about $8-9/hour-- those cheap bastaards. I just started slowly throwing away shiit like anesthesia drugs, blades, esophageal steths, soda lime, batteries and pretty much anything related to anesthesia. Months passed... The materials management and pharmacist squirrels were scratchin' their heads bigtime. I nonchalantly suggested in passing that the anesthesia tech kept everything in check and up to snuff. They reestablished the anesthesia tech position and things stopped disappearing. Moral of story-- Ole Zip doesn't do blades. Regards, ---Zippy

Zip, all your posts have a certain air of crabbiness to them...kinda like a hilarious sea captain that's been there done that. But this is your best post yet.

 

[Bertelman]

I worked as an anes tech for a couple of years before i started med school. I cant believe that yall just wash them with soap and water. We would wash them with soap, chemically sterilize for 15 mins, and rinse. Same for the scope. In addition, things that could be autoclaved, like LMAs, were autoclaved.

Soap and water sounds really shady

I'm not aware of any chemical sterilizer. I think you were chemically decontaminating. Then promptly rinsing in tap water.

I question the OP's usage of the word "soap". I'd venture to guess they were using hand scrub. Not perfect, but alot better than Ivory.

 

[Gern Blansten]

I have a friend named "Madge" who suggested Palmolive. She says it is gentle on your skin and also eliminates prions. It has been touted to have magical powers as well.

 

[zippy2u]

Well RN, in certain circles, I have been known as the "House" of anesthesia however I don't walk with a limp or munch on Vicodin. Regards, ----Zip

 

[TheSandMan]

lazy anesthesia techs? man, where did you train? our techs are awesome, save for one or two, and are always there to help out. i've never (personally) had a problem with not getting something when i need it, or having an extra pair of hands to set-up monitors and hand me stuff on a big case (ie., art lines, cvps, swans, etc.). they come to traumas with us. a great tech just knows what you want next, and i've been in many situations where i start to ask for something, turn my head, and it's already there in front of me in their hand.

sorry you had a bad experience. sounds like a management problem to me.

were prettyl lucky where im at too. our anesthesia techs rock. the are absolute machines. we have one who does part time at night, who will even help set up trauma rooms. literally gets the job done in half the time.

 

[bubalus]

I'm not aware of any chemical sterilizer. I think you were chemically decontaminating. Then promptly rinsing in tap water.

I question the OP's usage of the word "soap". I'd venture to guess they were using hand scrub. Not perfect, but alot better than Ivory.

How about glutaraldehyde for a chemical sterilizer?

 

[Bertelman]

How about glutaraldehyde for a chemical sterilizer?

Yeah, I guess I threw out a lazy comment. There's also EO, etc. Either way, I don't believe 15 minutes was sufficient to *sterilize* the equipment. Then there's still the tap water rinse.

Before I get corrected again, I meant disinfected, not decontaminated.

 

[logos]

At the hospital I used to work at anesthesia gave the blade to the circulating nurse after intubation. She puts it on the "case cart" which all the instruments came on and will leave on. Case cart goes down to the end of the hallway. People from sterile processing take care of the rest. Blade comes back up in a day or two in its own little sterile autoclave pouch. I used to have to make sure there were a few of each type and size of blade in each anesthesia machine.

 

[pratik7]

We used Cidex and this is the product profile.."with an excellent tuberculocidal and high level disinfection capabilities, has been proven to destroy 100% of Mycobacterium tuberculosis in 20 minutes at 25°C. It’s effective in the presence of 2% organic soil and – because it’s noncorrosive to instruments – provides a fast, effective option for the disinfection and sterilization of a wide range of materials. CIDEX PLUS 28 Day Solution is a 3.4% alkaline glutaraldehyde solution for up to a 28-day reuse life."

 

[Bertelman]

We used Cidex and this is the product profile.."with an excellent tuberculocidal and high level disinfection capabilities, has been proven to destroy 100% of Mycobacterium tuberculosis in 20 minutes at 25°C. It’s effective in the presence of 2% organic soil and – because it’s noncorrosive to instruments – provides a fast, effective option for the disinfection and sterilization of a wide range of materials. CIDEX PLUS 28 Day Solution is a 3.4% alkaline glutaraldehyde solution for up to a 28-day reuse life."

We used Cidex, too. I think that's why I have so many warts on my hands

 

[ZA_Gasman]

Where I work, (large teaching hospital) the Anaesthetic nurse takes the blades out to the scrub tray, runs water over them, maybe a little Hibitane or Iodine containing solution, dries with a piece of hand towel, and presto... The blade reappears in the table in time for the next case.

Have NEVER seen a laryngoscope blade in a sterilised bag. I also don't look too closely at the screw in light on the blade either. Makes me want to buy a coupla plastic disposable blades for use on myself and family members. Would clean blades myself, but no time, and no extra blades (us. only a 3 and a 4 per theatre) to use while sterilising the original blade. Then again, our minister of health still thinks HIV/AIDs can be cured by Garlic.

 

[Monty Python]

We used Cidex and this is the product profile.."with an excellent tuberculocidal and high level disinfection capabilities, has been proven to destroy 100% of Mycobacterium tuberculosis in 20 minutes at 25°C. It’s effective in the presence of 2% organic soil and – because it’s noncorrosive to instruments – provides a fast, effective option for the disinfection and sterilization of a wide range of materials. CIDEX PLUS 28 Day Solution is a 3.4% alkaline glutaraldehyde solution for up to a 28-day reuse life."

I've known a few people become allergic to Cidex or its fumes.

I might be wrong (wouldn't be the first time) but I thought JCAHO mandated vented rooms for Cidex trays. Same thing at the VA where I moonlight, where laryngoscope blades are passed through the Steris machine (which is what cleans colonoscopes). JCAHO wanted all those Steris rooms vented which the VA spent $$$ of taxpayer's money to comply.