it has been identified as a potential source of cross infection because of blood and bacterial contamination .
laryngoscopes are included in semicritical items according to the centers for disease control 's ( cdc 's ) healthcare infection control practices advisory committee ( hicpac ) , which minimally require high - level disinfection using chemical disinfectants .
glutaraldehyde , hydrogen peroxide , ortho - phthalaldehyde and peracetic acid with hydrogen peroxide are approved by the food and drug administration .
we carried out a survey amongst anaesthesiologists attending an anaesthesia conference to know their current practice of laryngoscope cleaning and disinfection techniques .
we designed a simple questionnaire regarding disinfection of laryngoscopes which was verified by five professors of anaesthesia from our teaching institute .
participation was voluntary , and participants were assured of maintaining anonymity and confidentiality . the questionnaire included 13 questions [ appendix 1 ] .
the study cohort included anaesthesiologists working in teaching hospitals , public hospitals , private nursing homes and corporate hospitals .
out of 250 delegates who attended the conference , 150 submitted the completed questionnaire . out of these 150 respondents , 69 ( 46% ) were consultants , 61 ( 41% ) were trainee residents and 20 ( 13% ) were clinical associates [ figure 1a ] .
sixty - eight ( 45% ) worked in teaching and public hospitals , 49 ( 33% ) delegates practiced in nursing homes and 33 ( 22% ) in corporate hospitals [ figure 1b ] .
the study respondents performed 5 laryngoscopies / day ( range 3 - 7 ) . on enquiring about who disinfected the laryngoscopes routinely
, 82 ( 55% ) respondents said it was done by operation theatre ( ot ) technicians , 46 ( 31% ) said it was done by ward boys and 22 ( 14% ) said they cleaned the laryngoscopes themselves .
( b ) area of current practice on asking about the method used for cleaning and disinfection of laryngoscope blades , 18 ( 12% ) respondents said they used only tap water for cleaning .
one hundred and thirty - two ( 88% ) used a chemical agent after rinsing with water . out of 132 , 76 ( 51% ) used detergent / soap solution , 29 ( 19% )
would wash and then soak in disinfectant or germicidal agents and 18 ( 12% ) would wipe the blade with an alcohol swab .
none of the respondents used autoclaving as a method for blade sterilisation . nine ( 6% ) were not aware of the method used [ figure 2 ] .
anaesthesiologists who would soak the laryngoscope blade in disinfectant / germicidal agent were further asked how they prepared the disinfectant solution .
seventy - two ( 48% ) did not respond to this question and 33 ( 22% ) were not aware of the solution used .
out of this 45 , 22 ( 15% ) used glutaraldehyde , 20 ( 13% ) used povidone iodine and 3 ( 2% ) used chlorhexidine .
time for immersion of the blades in the various solutions varied from 1 to 30 min .
a large percentage ( 89.6% ) of anaesthesiologists working in corporate hospitals was not aware of the method of disinfection used .
we did not find any difference regarding awareness of disinfection methods between residents and consultants .
methods of decontamination of laryngoscope blade when asked regarding the frequency of disinfection of blades , 136 ( 91% ) respondents said they did it after every case .
thirteen ( 8% ) would disinfect it after use in an infected patient and 2 ( 1% ) would clean it at the end of the day .
nearly 46% said they would clean it after every use , 32% would clean it only if blood or secretions were visible over the surface , 11% would clean it once in a while and 11% would not clean it at all [ figure 3 ] . disinfection of laryngoscope
handle on asking about the method of disinfection used for laryngoscope handles , 70% respondents said they used an alcohol swab , 18% did not use any method and 9% were not aware of the method being used , while 3% did not respond . regarding how sterility of laryngoscopes was assured ,
17% respondents said they used swab and culture method and 76% did not use any method .
on enquiring whether they had administered anaesthesia to infected patients , 97% of respondents said they had anaesthetised infected cases with hepatitis b , respiratory infections , dermatitis , psoriasis and retrovirus - positive patients . on enquiring about the methods of decontamination of such infected laryngoscopes , 28%
glutaraldehyde was used by 23% , 19% used disposable laryngoscope , 5% used autoclaving , 4% used chlorhexidine , 2% sterilised with eto ( ethylene oxide ) and 1% washed with hot water [ figure 4 ] .
decontamination of infected laryngoscope blades five of the respondents commented that they liked the questionnaire and requested that the survey results are mailed to them .
laryngoscopy is an invasive procedure involving contact of the laryngoscope with the mucous membrane , saliva , and at times even blood , making it a source of hospital - acquired infections . in 1986 , cdc published guidelines for disinfection of equipment .
they proposed that equipment which are in direct or indirect contact with mucus membrane or respiratory tract mucosa are classified as semicritical and need a high level of disinfection which destroys all forms of microorganisms except bacterial spores .
they suggested hot water pasteurisation ( 80c100c , for 30 min ) or exposure to environmental protection agency - registered sterilant chemical for short exposure time ( 1045 min ) .
the guidelines for preventing healthcare - associated pneumonia issued by cdc and hicpac recommend a detailed procedure for cleaning and disinfecting laryngoscopes .
they recommend thorough washing followed by disinfection with steam sterilisation or wet heat pasteurisation of these semicritical equipment .
the recommended chemical disinfectants are high - level disinfectants such as ethanol ( > 70% ) , formaldehyde , hypochlorite , ortho - phthalaldehyde and glutaraldehyde .
recent review articles suggest ineffectiveness of current methods of disinfection of reusable laryngoscopes and poor compliance with the established protocols . in india , there is no uniformity of laryngoscope disinfection practices . in our hospital too , different ots follow different practices for disinfection of laryngoscopes . in 2010 ,
a survey was carried out regarding existing practices of disinfection of laryngoscope in the indian context .
the authors also compared bacterial growth on front , back and light bulb of laryngoscope blade washing with water and washing with water followed by disinfection with 5% v / v aldehyde - free biguanide agent .
fifty - eight per cent samples of washing with only water showed growth of pathogenic microorganisms , whereas 3.4% samples of biguanide group showed growth of commensals .
the authors recommend disinfection with 5% w / v aldehyde - free biguanide agent for at least 10 min as an effective and inexpensive method . in this study ,
a subset of patients with oral cancer showed significant bacterial growth ( 52% ) due to suboptimal hygiene .
a recent online survey of 100 anaesthesiologists from tertiary hospitals in india found that many respondents considered laryngoscopes as a potential source of infection .
awareness regarding the need for cleaning and disinfection of laryngoscopes was high ( 94% for blade ; 89% for handle ) .
it may not come in direct contact with mucus membrane , but at closed position , the contaminated tip is always in contact with the handle .
various strategies to minimise contamination include improving methods of decontamination , use of disposable laryngoscopes or redesigning the handle to minimise contact points . even after appropriate disinfection
hence , along with standardisation of decontamination methods , there is a need to review protocols and policies surrounding the use of reusable blades .
this survey was conducted in a metro city where adequate resources in the form of staff , disinfectant materials , equipment and well - equipped microbiology laboratories are most often readily available .
standardisation of protocols for disinfection and availability of resources for all will help in minimising the risk of cross infection associated with laryngoscope blade and handles .
our survey showed a high level of awareness regarding methods of decontamination of laryngoscopes amongst anaesthesiologists . in india ,
national guidelines for decontamination of anaesthesia equipment are necessary . we need to standardise and implement guidelines on a national level and make available resources which will help to improve patient safety .
 background and aims : the laryngoscope is a common piece of equipment used by anaesthesiologists . 
 it has been identified as a potential source of cross infection . 
 although guidelines exist regarding appropriate disinfection practices , recent reviews suggest ineffectiveness of current methods of disinfection and poor compliance with the established protocols . we conducted a questionnaire - based survey to study the current disinfection practices being followed by a cross section of anaesthesiologists.methods:a simple questionnaire containing 13 questions 
 was distributed amongst anaesthesiologists in an anaesthesia conference . 
 data were analysed with percentage analysis.results:out of 250 delegates who attended the conference , 150 submitted the completed questionnaires . 
 residents constituted 41% and 46% were consultants . 
 eighteen ( 12% ) used only tap water for cleaning and 132 ( 88% ) used a chemical agent after rinsing with water . 
 out of 132 , 76 ( 51% ) used detergent / soap solution , 29 ( 19% ) would wash and then soak in disinfectant or germicidal agents ( glutaraldehyde , povidone iodine and chlorhexidine ) and 18 ( 12% ) would wipe the blade with an alcohol swab . 
 with respect to disinfection of laryngoscope handles , 70% respondents said they used an alcohol swab , 18% did not use any method , 9% were not aware of the method being used , while 3% did not respond.conclusion:our results indicate wide variation in methods of decontamination of laryngoscopes . 
 awareness regarding laryngoscope as a potential source of infection was high . 
 we need to standardise and implement guidelines on a national level and make available resources which will help to improve patient safety . 
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION
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