title: A New Approach to Pathogen Containment in the Operating Room: Sheathing the Laryngoscope After Intubation.
abstract: BACKGROUND
  Anesthesiologists may contribute to postoperative infections by means of the transmission of blood and pathogens to the patient and the environment in the operating room (OR). Our primary aims were to determine whether contamination of the IV hub, the anesthesia work area, and the patient could be reduced after induction of anesthesia by removing the risk associated with contaminants on the laryngoscope handle and blade. Therefore, we conducted a study in a simulated OR where some of the participants sheathed the laryngoscope handle and blade in a glove immediately after it was used to perform an endotracheal intubation.
  
  
  METHODS
  Forty-five anesthesiology residents (postgraduate year 2-4) were enrolled in a study consisting of identical simulation sessions. On entry to the simulated OR, the residents were asked to perform an anesthetic, including induction and endotracheal intubation timed to approximately 6 minutes. Of the 45 simulation sessions, 15 were with a control group conducted with the intubating resident wearing single gloves, 15 with the intubating resident using double gloves with the outer pair removed and discarded after verified intubation, and 15 wearing double gloves and sheathing the laryngoscope in one of the outer gloves after intubation. Before the start of the scenario, the lips and inside of the mouth of the mannequin were coated with a fluorescent marking gel. After each of the 45 simulations, an observer examined the OR using an ultraviolet light to determine the presence of fluorescence on 25 sites: 7 on the patient and 18 in the anesthesia environment.
  
  
  RESULTS
  Of the 7 sites on the patient, ultraviolet light detected contamination on an average of 5.7 (95% confidence interval, 4.4-7.2) sites under the single-glove condition, 2.1 (1.5-3.1) sites with double gloves, and 0.4 (0.2-1.0) sites with double gloves with sheathing. All 3 conditions were significantly different from one another at P < 0.001. Of the 18 environmental sites, ultraviolet light detected fluorescence on an average of 13.2 (95% confidence interval, 11.3-15.6) sites under the single-glove condition, 3.5 (2.6-4.7) with double gloves, and 0.5 (0.2-1.0) with double gloves with sheathing. Again, all 3 conditions were significantly different from one another at P < 0.001.
  
  
  CONCLUSIONS
  The results of this study suggest that when an anesthesiologist in a simulated OR sheaths the laryngoscope immediately after endotracheal intubation, contamination of the IV hub, patient, and intraoperative environment is significantly reduced.
authors.affiliation: From the *Department of Anesthesiology, University of Miami - Jackson Memorial Hospital Center for Patient Safety, University of Miami Miller School of Medicine, Miami, Florida; †Department of Medicine Infectious Diseases, Boston Medical Center, Boston, Massachusetts; ‡Department of Public Health Science, University of Miami Miller School of Medicine, Miami, Florida; and §Institute for Health and Society, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: David J
authors.initials: DJ
authors.lastname: Birnbach
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Rosen
authors.forename: Maureen
authors.initials: M
authors.lastname: Fitzpatrick
authors.forename: Philip
authors.initials: P
authors.lastname: Carling
authors.forename: Kristopher L
authors.initials: KL
authors.lastname: Arheart
authors.forename: L Silvia
authors.initials: LS
authors.lastname: Munoz-Price
mesh_terms: D000776:Anesthesiology / Q000193:education / Q000379:methods / Q000592:standards*; D003264:Containment of Biohazards / Q000379:methods / Q000592:standards*; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D005932:Gloves, Surgical / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards; D007442:Intubation, Intratracheal / Q000379:methods / Q000592:standards*; D020704:Laryngoscopes / Q000382:microbiology / Q000592:standards*; D008297:Male; D009873:Operating Rooms / Q000379:methods / Q000592:standards*