title: Laryngoscope Illuminance in a Tertiary Care Medical Center: Industry Standards and Implications for Quality Laryngoscopy.
abstract: OBJECTIVE
  To test the hypothesis that a substantial proportion of laryngoscopes exhibit substandard illuminance by comparing laryngoscope illuminance in a tertiary-level medical center to established standards and identifying features associated with poor illuminance.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  Academic tertiary care medical center (level 1 trauma center, specialty cardiac hospital, and general hospital).
  
  
  METHODS
  Laryngoscopes from main, cardiac, and outpatient operating rooms; emergency department; and code carts were tested using a standard technique. Illuminance (lux) was chosen as the outcome measure. Benchmarks were derived from the International Standards Organization and medical literature. Light types included incandescent bulb, light-emitting diode, and xenon. Personnel were surveyed regarding maintenance practices.
  
  
  RESULTS
  Across all hospitals, 691 laryngoscopes were tested. Mean (SD) illuminance was 810 (700) lux for incandescent bulb-on-blade designs (n = 237), 1860 (1220) lux for incandescent bulb in-handle designs (n = 79), 4730 (3210) lux for LED (n = 354), and 28,800 (34,500) lux for xenon (n = 21). Seven percent of units failed to turn on (n = 45). Using an established threshold of 867 lux, 28% of devices (47% of incandescent, 12% of LED, and 10% of xenon) were substandard. All laryngoscopes were cleaned according to standard protocols following use; no preventive maintenance was reported.
  
  
  CONCLUSIONS
  Twenty-eight percent of laryngoscopes in a tertiary care hospital exhibit substandard illuminance; these results corroborate the findings of our inaugural study on this subject. Consequently, our hospital is instituting changes to reduce the likelihood of substandard performance by laryngoscopes in circulation.
authors.affiliation: Eastern Virginia Medical School, Norfolk, Virginia, USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Murphy
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Volsky
authors.affiliation: Departments of Otolaryngology and Pediatrics, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA david.darrow@chkd.org.
authors.forename: David H
authors.initials: DH
authors.lastname: Darrow
mesh_terms: D003430:Cross-Sectional Studies; D004867:Equipment Design; D006801:Humans; D007221:Industry / Q000592:standards*; D020704:Laryngoscopes / Q000592:standards*; D007828:Laryngoscopy / Q000592:standards*; D008029:Lighting / Q000295:instrumentation*; D009873:Operating Rooms / Q000592:standards*; D062606:Tertiary Care Centers
keywords: airway management; device failure; device performance; emergency medical services; intratracheal; intubation; laryngoscopy; light; lighting; quality assurance; quality control