This document summarizes several studies that investigated the use of disposable laryngoscope blades compared to reusable blades. The studies looked at various outcomes such as the presence of blood contamination on reusable blades, ease of use, failed intubations, flexibility, and cost. Overall, the studies found higher rates of blood contamination on reusable blades and easier use but lower quality of disposable blades, with mixed results on failed intubations. User satisfaction tended to be higher for reusable blades when they functioned properly.

1. Emerging Evidence in
Infection Control Effecting
Change
Melissa D. Machan, ARNP,CRNA

2. Background
Nosocomial infections cost hospitals a
great deal of money every year and affect
a large amount of patients admitted to the
hospital.
Nosocomial infections could potentially
result from visible and occult blood
present on reusable anesthetic airway
equipment.
It has been established that the current
methods for sterilizing and storing
reusable laryngoscope blades are
ineffective.

3. Background Continued
Intubation of the trachea has been a risky
cross-contamination procedure over the past
couple of decades because no perfect
decontamination procedure exists.
Disposable laryngoscope blades have been
made available to prevent potential cross
contamination while intubation of the trachea is
being performed.
These single use disposable laryngoscope
blades have come with mixed reviews from
anesthesia providers.

4. Purpose of the Project
The purpose of this evidence based project is to
determine the perceptions of anesthesia
providers regarding the use of a disposable
laryngoscope blade, their frequency of use, their
evaluation of ease of use, and any complications
encountered when using the disposable blade
before and after an in-service program designed
to increase use of disposable blades.

5. PICO Question
In patients requiring intubation (P), how does the
use of a disposable laryngoscope blade (I)
compared with a reusable laryngoscope blade
(C) affect ease of use, complications, and cost
(O)?

6. Research Questions
What is the perception of anesthesia providers
regarding ease of use, complications, and cost
of disposable laryngoscope blades before and
after the in-service program?
What percent of anesthesia providers use
disposable laryngoscope blades before and
after the in-service program?
How many disposable laryngoscope blades
were used in the facility in the 3-months before
and after the in-service program?

7. Research Questions
What is the anesthesia providers’ evaluation of
ease of use of the disposable laryngoscope
blade?
What are the providers’ rationales for non-use
of a disposable laryngoscope blade after the in-
service-program?
What complications did anesthesia providers
encounter when using a disposable
laryngoscope blade?

8. Studies Investigating the
Presence of Visible and Occult
Blood on Laryngoscope
Blades and Handles
Author/Date Design Sample Outcome Interventions Results Limitations
Williams et al. Randomized 192 specimens Assessed for Laryngoscope One or more Inadequate
(2010) blinded Study from 64 bacterial handles. species of sensitivity of
laryngoscope contamination bacteria the
handles and occult were isolated detection of
deemed „ready blood. from 55(86%) blood methods
for patient use‟ of the handles. employed.
in the No occult Sites B and C
anesthetic blood were swabbed
rooms contamination for microbial
of 32 was contamination
operating demonstrated. prior to
theatres. sampling for
occult blood.

9. Studies Investigating the
Presence of Visible and Occult
Blood on Laryngoscope
Blades and Handles
Author/Date Design Sample Outcome Interventions Results Limitations
Phillips & Prospective Sixty-five Presence of Visible and None of the Contamination
Monaghan observational laryngoscope occult blood occult blood blades or could have
(1997) study blades and on handles happened after
handles laryngoscope observed had the
identified as blades and visible blood. sterilization
ready for handles that Of the 65
patient use were blades tested
were observed identified as for occult
for visible ready for blood, 10
blood and patient use (20%) tested
tested for positive. Of
occult blood the 65 handles
tested for
occult blood,
26 (40%)
tested positive.

10. Studies Investigating the
Presence of Visible and Occult
Blood on Laryngoscope
Author/DateBlades and Handles
Esler et al.
Design
Questionnaire
Sample
Of the 289
Outcome
Cleaning
Interventions
Survey
Results
One third of
Limitations
Conducted
(1999) questionnaires methods methods of the units the outside the
sent out, 239 laryngoscope handle is not United States
were returned. cleaning in cleaned at all.
units through Only 5%
Great Britain. routinely
autoclave the
handle and in
12% of the
units,
disposable
laryngoscopes
are used. One
third would
not be
prepared to
put a cleaned
blade into
their mouth.

11. Studies Investigating the Ease
of Use of Disposable
Laryngoscope Blades
Author/Date Design Sample Outcome Interventions Results Limitations
Anderson et Randomized 32 anesthetists Ease of use Standard “Easy” Although a
al. (2006) unblindedstud with between reusable setting: high-fidelity
y 11 months and laryngoscope laryngoscopy patient
25 years of blades more difficult simulator
experience with the allows for
using a high- Standard covered blade standardized,
fidelity reusable ( p= 0.001) reproducible
simulator laryngoscope and the intubating
blades with disposable conditions
disposable blades. there is debate
blade covers “Difficult” as to whether
setting: it is an
Disposable laryngoscopy adequately
laryngoscope more difficult validated tool
blades with both the for assessment
covered of anesthetists.
blades (22%,
p=0.008)and
the disposable
blades (69%,
p<0.001)

12. Studies Investigating the Ease
of Use of Disposable
Laryngoscope Blades
Author/Date Design Sample Outcome Interventions Results Limitations
Sudhir et al. Manikin based 11 disposable Ease of use Disposable Better user Not blinded,
(2007) observational and standard and standard satisfaction user bias
study re-usable re-usable with metal
Miller size 1 Miller size 1 disposable
blades blades blades
(p<0.001).
Greater force
needed with
plastic blades.

13. Studies Investigating the Ease
of Use of Disposable
Laryngoscope Blades
Author/Date Design Sample Outcome Interventions Results Limitations
Rassam, et al. Observational Fifty Ease of One metal re- Ease of Not blinded,
(2005) study anesthetists attachment of usable attachment, user bias
were recruited the blade to blade, five illumination,
to use 20 the handle; metal single- view, clinical
different illumination; use blades and use, force and
laryngoscope view of the 14 plastic duration were
blades (one larynx; and single-use all
metal re- satisfaction blades. significantly
usable for clinical affected by the
blade, five use. The peak blade used (p
metal single- force applied < 0.0001 for
use blades and and time to all six). Two
14 plastic achieve the plastic blades
single-use grade I provided a
blades. Cormack and poor view and
Lehane view increased the
were also duration of
measured. laryngoscopy.

14. Studies Investigating Failed
Intubation with Disposable
Laryngoscope Blades
Author/Date Design Sample Outcome Interventions Results Limitations
Amour et al. Randomized 1,072 adult Failed Single-use Significantly Not blinded
(2010) clinical trial patients Intubation metal more failed
undergoing laryngoscope intubation
general blade, with reusable
anesthesia reusable metal blades (5.4
under laryngoscope versus 2.8%,
emergency blade p<0.05).
conditions and
requiring
rapid
sequence
induction
(RSI).

15. Studies Investigating Failed
Intubation with Disposable
Laryngoscope Blades
Author/Date Design Sample Outcome Interventions Results Limitations
Amour et al. Cluster 284 adult Failed Plastic single- Significantly Not blinded
(2006) Randomized patients were Intubation use more failed
clinical trial randomly laryngoscope intubations on
assigned on a blades, Metal the first
weekly basis reusable attempt with
to either laryngoscope the plastic
plastic single blades single use
use or laryngoscope
reusable metal blade (17%
blades. vs. 3%,
p<0.01).

16. Studies Investigating Failed
Intubation with Disposable
Laryngoscope Blades
Author/Date Design Sample Outcome Interventions Results Limitations
Galinski et al. Prospective 119 Failed Vital View Of the 119 Not blinded,
(2003) observational intubations Intubation disposable first attempts user bias
study were laryngoscope using the
perfumed blades disposable
using blades only 12
disposable blade changes
blades and had to be
100 performed
intubations before
were successful
performed intubation
using
traditional
metal blades
on the first
attempt.

17. Studies Investigating Failed
Intubation with Disposable
Laryngoscope Blades
Author/Date Design Sample Outcome Interventions Results Limitations
Shahriari et al. Prospective 200 patients Failed Disposable The The
(2007) study that were Intubation laryngoscope disposable anesthetists
randomly blade and the laryngoscope had different
divided into reusable blade group levels of
two groups. laryngoscope had a 14% experience
blade. incidence of
failed
intubation and
21% incidence
of prolonged
intubation.

18. Studies Investigating Failed
Intubation with Disposable
Author/Date
Laryngoscope Blades
Design Sample Outcome Interventions Results Limitations
Jabre et al. Observational Intubated with Failed Metallic blade The first- Not blinded,
(2007) before-and- metallic Intubation plastic blade attempt user bias
after study blade(594/117 intubation
7) and with a success rate
plastic blade was higher
(583/1177). in the metallic
blade group.
The incidence
of difficult
intubation was
lower when
metallic
blades were
used. A good
laryngeal view
was more
frequently
observed with
metallic blade
use.

19. Studies Investigating Flexibility
and Light Emission of the
Disposable Laryngoscope
Author/Date Blade
Design Sample Outcome Interventions Results Limitations
Goodwin et al. Observational Eleven Miller Flexibility and Disposable There was a No standard
(2006) study 1 blades. 3 light emission and re-usable significant set as to the
new samples Miller 1 difference in degree of
of each blade. Blades flexibility flexibility that
between metal is acceptable.
and plastic
blades
(p=0.006). An
eightfold
difference in
level of
illumination
provided.

20. Studies Investigating Flexibility
and Light Emission of the
Disposable Laryngoscope
Author/Date Blade
Design Sample Outcome Interventions Results Limitations
Cheung et al. Observational Fifty-one Illumination New Batteries, Fourteen All
(2007) study laryngoscopes new bulb, new percent of measurements
batteries and laryngoscopes were made
new bulb, and (7/51) from one
attachment of at baseline ambulance
a disposable met the base. Results
blade minimal may not be
illumination generalizable.
criterion.

21. Studies Investigating Cost,
User Satisfaction and Provider
Preference
Author/Date Design Sample Outcome Interventions Results Limitations
Romig, L. Methodical 17 studies Disposable Cost, user Decision to EMS
(2008) Problem laryngoscope satisfaction, transition to practitioners
analysis blades or quality disposable
reusable management, equipment
laryngoscope risk
blades management

22. Studies Investigating Cost,
User Satisfaction and Provider
Author/Date
Preference
Design Sample Outcome Interventions Results Limitations
Rowley Survey, focus Eight English Quality and Provider Despite
&Dingwall group and NHS Trusts efficacy of preference reservations
(2007) interview covering 12 single-use about induced
methodologies hospital sites laryngoscope harm and the
. was selected. blades unknown risk
Twenty-three of an
interviews iatrogenic
were disease, most
completed. clinicians
would want
single-use
devices used
on themselves
and their
family if they
were patients.