title: Nosocomial contamination of laryngoscope handles: challenging current guidelines.
abstract: BACKGROUND
  Laryngoscope blades are often cleaned between cases according to well-defined protocols. However, despite evidence that laryngoscope handles could be a source of nosocomial infection, neither our institution nor the American Society of Anesthesiologists has any specific guidelines for handle disinfection. We hypothesized that laryngoscope handles may be sufficiently contaminated with bacteria and viruses to justify the implementation of new handle-cleaning protocols.
  
  
  METHODS
  Sixty laryngoscope handles from the adult operating rooms were sampled with premoistened sterile swabs. Collection was performed between cases, in operating rooms hosting a broad variety of subspecialty procedures, after the room and equipment had been thoroughly cleaned for the subsequent case. Samples from 40 handles were sent for aerobic bacterial culture, and antimicrobial susceptibility testing was performed for significant isolates. Samples from 20 handles were examined for viral contamination using a polymerase chain reaction assay that detects 17 respiratory viruses.
  
  
  RESULTS
  Of the 40 samples sent for culture, 30 (75%) were positive for bacterial contamination. Of these positive cultures, 25 (62.5%) yielded coagulase-negative staphylococci, seven (17.5%) Bacillusspp. not anthracis, three (7.5%) alpha-hemolytic Streptococcusspp., and one each (2.5%) of Enterococcusspp., Staphylococcus aureus(S. aureus), and Corynebacteriumspp. No vancomycin-resistant enterococci, methicillin-resistant S. aureus, or Gram-negative rods were detected. All viral tests were negative.
  
  
  CONCLUSIONS
  We found a high incidence of bacterial contamination of laryngoscope handles despite low-level disinfection. However, no vancomycin-resistant enterococci, methicillin-resistant S. aureus, Gram-negative rods, or respiratory viruses were detected. Our results support adoption of guidelines that include, at a minimum, mandatory low-level disinfection of laryngoscope handles after each patient use.
authors.affiliation: Department of Anesthesiology, College of Medicine, State University of NY Upstate Medical University, Syracuse, New York 13210, USA.
authors.forename: Tyler R
authors.initials: TR
authors.lastname: Call
authors.forename: Frederic J
authors.initials: FJ
authors.lastname: Auerbach
authors.forename: Scott W
authors.initials: SW
authors.lastname: Riddell
authors.forename: Deanna L
authors.initials: DL
authors.lastname: Kiska
authors.forename: Sumena C
authors.initials: SC
authors.lastname: Thongrod
authors.forename: See Wan
authors.initials: SW
authors.lastname: Tham
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Nussmeier
mesh_terms: D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000382:microbiology* / Q000517:prevention & control; D003470:Culture Media; D003666:Decontamination / Q000592:standards*; D016983:Enterococcus / Q000187:drug effects; D005260:Female; D016987:Gram-Positive Rods / Q000187:drug effects; D017408:Guidelines as Topic; D006801:Humans; D020704:Laryngoscopes / Q000382:microbiology* / Q000592:standards; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008875:Middle Aged; D020133:Reverse Transcriptase Polymerase Chain Reaction; D020713:Vancomycin Resistance; D014780:Viruses / Q000737:chemistry; D055815:Young Adult
chemical_list: D003470:Culture Media