Mandated wrapping of airway cart instruments: Limited access without the intended safety benefits

Abstract

Objectives/Hypothesis Isolated case studies have shown improper sterilization or contamination of equipment from anesthesia carts can lead to transmission of disease and even death. Citing this literature, national accrediting agencies mandated all instruments in the otolaryngology airway carts at San Antonio Military Medical Center be packaged to prevent contamination. This study sought to determine the infection and safety implications of packaged airway cart instruments. Study Design Retrospective chart review. Methods A review of upper aerodigestive tract procedures, some of which penetrated mucosa, was performed by analyzing 100 patient records during the unpackaged period and 100 during the packaged period. A comparison of infections, deaths, and length of stay in the hospital was included in the analysis. Additionally, a timed simulation to setup a simple group of instruments for an emergency airway situation from both the unpackaged and packaged airway carts was performed using a total of 11 surgical technologists and nurses. Results Each group had a total of four airway infections and neither had any deaths. The average length of hospital stay was 0.36 days for the unpackaged period and 0.44 days from the packaged period. None of these variables reached statistical significance. The average time to find and set out the correct instruments for the two groups was 46.6 and 95.5 seconds for the unpackaged and packaged airway carts, respectively (P = .004). Conclusions This study suggests individually packaging of instruments used for emergency airway cases may put lives at risk when time matters and fails to decrease the risk of infection. Level of Evidence 3 Laryngoscope, 129:715–719, 2019

Quality Improvement of Pediatric Airway Emergency Carts: Standardization, Streamlining, and Simulation

“…A recent retrospective chart review compared infection rates and time to assemble instruments for two groups of 100 patients, one before and the other after such a policy was implemented for otolaryngology airway carts at a single institution. This revealed that neither the infection rate nor length of hospital stay decreased and that the time required for equipment assembly doubled [ 17 ]. Another study reported that reducing the amount of packaging on the emergency airway cart reduced both assembly time and time to visualization of the trachea by two to four minutes [ 18 ].…”

Storage of Emergency Airway Equipment on Labor and Delivery Units

“…While maintaining airway equipment in unopened sterile packaging may reduce the risk of nosocomial pneumonia, there is no evidence of increased pneumonia risk from using sterilized, opened equipment stored in a clean, but not sterile, manner 1,2 . Bacteria detected in nosocomial pneumonia after endotracheal intubation are normally oral flora, 3 and these bacteria are not found growing on preprepared endotracheal tubes.…”

“…While maintaining airway equipment in unopened sterile packaging may reduce the risk of nosocomial pneumonia, there is no evidence of increased pneumonia risk from using sterilized, opened equipment stored in a clean, but not sterile, manner. 1,2 Bacteria detected in nosocomial pneumonia after endotracheal intubation are normally oral flora, 3 and these bacteria are not found growing on preprepared endotracheal tubes. As a compromise with the Infection Control and Prevention Department, the authors were permitted to store airway equipment in an opened state inside a wipeable plastic box on the front shelf of each anesthesia machine in L&D, ensuring readiness for emergency use.…”

Use of Intraoperative Red Cell Salvage in the Contemporary Management of Placenta Accreta Spectrum Disorders

“…The maneuverability and light function of unopened packaged laryngoscope blades and handles cannot be tested before assembly, posing a potential risk if the equipment malfunctions.While maintaining airway equipment in unopened sterile packaging may reduce the risk of nosocomial pneumonia, there is no evidence of increased pneumonia risk from using sterilized, opened equipment stored in a clean, but not sterile, manner. 1,2 Bacteria detected in nosocomial pneumonia after endotracheal intubation are normally oral flora, 3 and these bacteria are not found growing on preprepared endotracheal tubes. As a compromise with the Infection Control and Prevention Department, the authors were permitted to store airway equipment in an opened state inside a wipeable plastic box on the front shelf of each anesthesia machine in L&D, ensuring readiness for emergency use.The authors advocate for a more rational approach by The Joint Commission (TJC) and Centers for Disease Control and Prevention (CDC) regarding sterile packaged airway equipment.…”

“…While maintaining airway equipment in unopened sterile packaging may reduce the risk of nosocomial pneumonia, there is no evidence of increased pneumonia risk from using sterilized, opened equipment stored in a clean, but not sterile, manner. 1,2 Bacteria detected in nosocomial pneumonia after endotracheal intubation are normally oral flora, 3 and these bacteria are not found growing on preprepared endotracheal tubes. As a compromise with the Infection Control and Prevention Department, the authors were permitted to store airway equipment in an opened state inside a wipeable plastic box on the front shelf of each anesthesia machine in L&D, ensuring readiness for emergency use.…”