Laryngoscopes

There are many factors to consider when purchasing new equipment. Thinking about how easy or difficult it will be to comply with provincial standards for cleaning, disinfection or sterilization before purchasing each item will save time, trouble and money in the long run.

 

Question
Considerations

1

What are the cleaning requirements?
  • Laryngoscope blades and handles may have different Spaulding classifications and different processing instructions provided by manufacturers. Midwives need an IPAC plan for both.
  • The blades are semi-critical and must always be sterile.
  • Different public health sources classify laryngoscope handles as either non-critical or semi-critical.*
  • The Manufacturer’s Instructions for Use (MIFU) for different brands of laryngoscope handles also vary in terms of the recommended processing.

2

Can I clean it?
  • If the practice group does not do reprocessing onsite or have access to outsourcing, blades must be disposable.
  • As mentioned in Question 1 above, some IPAC expert sources describe laryngoscope handles as non-critical (not coming into contact with mucous membranes) and some describe handles as semi-critical (because they may come into contact with mucous membranes or cross contaminate the blade which is semi-critical).
  • The MIFU for brands such as Heine and Welch Allyn leave the decision about whether the handle is non-critical or semi-critical to the user. They describe disinfection processes for those who treat the handle as non-critical and sterilization processes for those who consider the handle semi-critical.

3

Are there better or easier to clean alternatives?
  • The best IPAC choice for midwives without access to sterilization may be disposable laryngoscope handles (e.g. BOMImed) or disposable handle shells (Heine) and disposable blades.
  • Consider the choice between metal and plastic disposable blades in terms of effectiveness for intubation.
  • Check for expiry dates on disposable items. As laryngoscopes are rarely used, far off expiration dates or no expiration dates are most desirable.
  • Check if the laryngoscope light can be tested at every birth without attaching the blade so the blade is not contaminated by repeated handling.

4
What is the IPAC plan for this item?
  • Midwives who have access to sterilization onsite or through outsourcing may choose reusable handles and blades.
  • Confirm that your practice has an IPAC plan for both blades and handles, or purchase disposables for both.Your plan must include a decision about whether you consider the handle non-critical or semi-critical. If you are concerned that cross contamination may occur between the handle and the blade, the handle should be sterilized between uses or disposable.

 

* Laryngoscope handles are not intended to come into contact with mucous membranes, which suggests that they are non-critical items that require only Low Level Disinfection (LLD) between uses.(2) However, some IPAC experts have expressed concern about the potential for cross-contamination between laryngoscope blades and laryngoscope handles. Some PIDAC sources do not distinguish between the blade and the handle and recommend sterilization of both.(3) The Canadian Standards Association (CSA) does not specifically discuss laryngoscope handles, but recommends that blades be kept sterile in plastic bags or peel packs until use. (4)

For general considerations and links to other equipment, see the AOM’s Equipment Purchasing Guide.

Brands of Laryngoscopes

Manufacturers’ instructions for use of laryngoscopes change over time. The following summaries were prepared by the AOM in 2019 to assist midwives with their purchasing decisions. The summaries also identify problems that may occur as a practice tries to comply with the manufacturer’s instructions for different brands. Consult the most recent MIFU for the brand you are considering before purchase.

Welch Allyn

  • Welch Allyn sells reusable laryngoscope handles and blades.
  • Welch Allyn blades are autoclavable.
  • Welch Allyn recommends intermediate-level disinfection for their handles, which can be accomplished with a quaternary ammonium isopropanol-based germicidal cleaner (e.g.  CaviWipes) or sterilization by immersion or autoclaving.
  • Welch Allyn does not sell disposable blades, so the handle is not practical for those without access to sterilization unless a compatible disposable blade can be purchased.

Heine

  • Heine sells reusable blades and plastic disposable blades. Heine’s MIFU recommends against using metal disposable blades with their handles.
  • Heine recommends either steam sterilization (autoclaving) or immersion reprocessing for their reusable handles. Immersion reprocessing is usually not an option for midwives unless they are outsourcing. Steam sterilization can be done in clinic with an autoclave or outsourced.
  • MIFU describe the steps for manual cleaning prior to sterilization.
  • There are several different designs of handles in the Heine brand line. The EasyClean handle is fully submersible without removing the batteries or LED which is an advantage for cleaning prior to sterilization and for outsourcing for immersion reprocessing. Batteries must be removed prior to autoclaving.
  • Heine also sells reusable laryngoscope handle inserts, which contain the light source and fit inside disposable handle shells. The insert is protected from contamination and the shell is discarded after use.

BOMImed

  • BOMImed sells reusable laryngoscope handles and blades.
  • BOMIMed also sells disposable handles and metal blades. The disposable system is fibre optic. These products have no expiry date, which is helpful for seldom-used items.
  • BOMImed reports that their disposable metal blades are compatible with handles manufactured by other companies. Heine recommends against using metal disposable blades with their handles.

 

References

(1) Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Best practices for environmental cleaning for prevention and control of infections in all health care settings. 3rd ed. Toronto, ON: Queen’s Printer for Ontario; 2018. (19-21)

(2) Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Best practices for infection prevention and control in perinatology, in all health care settings that provide obstetrical and newborn care. 1st revision, February 2015.b Toronto, ON: Queen’s Printer for Ontario; 2015. (73)

(3) Ontario Agency for Health Protection and Promotion (Public Health Ontario). Provincial Infectious Diseases Advisory Committee. Best practices for cleaning, disinfection and sterilization of medical equipment/devices. 3rd ed. Toronto, ON: Queen’s Printer for Ontario; May 2013. (72)

(4) Canadian Standards Association. (2015). Canadian medical device reprocessing. CAN/CSA-Z314-18 (Revised 2018). Toronto, ON: CSA Group. Retrieved from CSA Online Subscription Service. (125)